Proximal femur fractures in children - A narrative review

Abstract

Background: Proximal femur fractures are of fundamental importance in pediatric traumatology because, although rare and accounting for 1% of all the fractures, 33% tend to develop a high rate of complications. To decide on how to conduct these fractures and to orient the families, it is essential to understand their epidemiological and pathophysiological aspects. Methods: We conducted a literature review to explore characteristics related to epidemiological data, pathophysiological aspects, and treatment principles in proximal femur fractures in children. Results: We present an updated review of all aspects related to this type of fracture in the pediatric population, with a main focus on aspects related to treatment and complications. Surgical indications, implant options and the main operative techniques currently performed are discussed. The ideal treatment is based on anatomical reduction, stable fixation and surgery in the first 24 h after the trauma, but there are controversies on whether to perform an open or closed reduction, percutaneous capsulotomy and on how to treat the proximal femoral osteonecrosis and non-union. Conclusion: Fractures of the proximal femur in children are rare and difficult to manage, with a high rate of complications. This narrative review works as a guide to evidence-based treatment.

Keywords

• Pediatric proximal femur fracture
• Fractures of the proximal femur in children
• Pediatric femoral neck fracture
• Hip fracture
• Delbet classification
• Osteonecrosis