Unusual Fracture Patterns Associated with Hip Dislocation Surgical and Applied Anatomy Treatment Options Surgical Procedures

Fractures of the head and neck of the femur in children are exceedingly rare, accounting for fewer than 1 % of all pediatric fractures ( 24). In comparison, the prevalence of fractures of the hip in children is less than 1 % of that in adults. Therefore, most orthopaedic surgeons will treat only a few such fractures in a lifetime (16). The pattern of fracture and thus the classification in children differ from those in adults. Because of the weak proximal femoral physis, a transphyseal separation can occur in children. Transcervical and cervicotrochanteric fractures have an extremely high risk for avascular necrosis (AVN) and coxa vara compared with their adult counterparts. Intertrochanteric fractures are mechanically similar in both groups, although in children involvement of the greater trochanteric apophysis can result in premature closure. The proximal femoral physis is at risk in hip fracture and has obvious implications for fracture care and prognosis. If the proximal physis is damaged, coxa vara or coxa breva may develop with further growth regardless of fracture alignment. Conversely, if the greater trochanter apophysis fuses prematurely as a result of trauma, coxa valga may develop (4). Although hip fractures in children can generally be expected to heal, their importance lies in the frequency and severity of complications, including AVN, coxa vara, premature physeal closure, limb length discrepancy and occasionally nonunion. Because the hip is developing in the growing child, deformities can progress with age. Diagnosis Mechanism of Injury Hip fractures in children can be caused by axial loading, torsion, hyperabduction, or a direct blow to the hip. Almost all hip fractures in children are caused by severe