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Fractures of the Proximal Femur in Childhood: A Review

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Abstract

Background

Femoral neck fractures in children are rare injuries, occurring due to high-energy trauma. Due to the unique anatomy and blood supply of the proximal femur in growing children, these fractures are notorious for high rates of complications despite appropriate management. Classification of these fractures is according to the Delbet system, which not only guides management but also gives prognostic clues. Multiple fixation methods have been described and there is no consensus on what constitutes the best treatment. Osteonecrosis, non-union, coxa vara and premature physeal arrest are the most frequent complications.

Purpose

To review the current knowledge, discuss controversial aspects, and provide suggestions for future research.

Methods

We have reviewed the literature on paediatric proximal femur fractures and have provided an evidence-based guide to the diagnosis and management of these injuries. Common complications have been elaborated and options for their prevention and/or management discussed.

Conclusion

There is universal agreement that anatomic reduction and stable internal fixation, supplemented by spica immobilization in younger children, are essential to obtain good outcomes. The role of capsular decompression, choice and configuration of implant, and appropriate timing of surgery are aspects that continue to be debated. Multicenter prospective studies are necessary to standardize treatment of these challenging injuries.

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Fig. 1

Adapted from Ref. [11]

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Acknowledgements

We thank Mr. Darrell J. D’souza for illustrating Fig. 1.

Funding

This study has no funding support.

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Authors and Affiliations

  1. Department of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai, Maharashtra, 400012, India

    Deepika A. Pinto & Alaric Aroojis

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  1. Deepika A. Pinto
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  2. Alaric Aroojis
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Contributions

AA contributed to the study conception and design. Material preparation, data collection and analysis were performed by DP and AA. The first draft of the manuscript was written by DP and both authors commented on previous versions of the manuscript. Both authors read and approved the final manuscript.

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Correspondence to Alaric Aroojis.

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Pinto, D.A., Aroojis, A. Fractures of the Proximal Femur in Childhood: A Review. JOIO 55, 23–34 (2021). https://doi.org/10.1007/s43465-020-00259-4

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