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Pediatric Subtrochanteric Femur Fracture
synonyms:
Pediatric Subtrochanteric Femur Fracture ICD-9
Pediatric Subtrochanteric Femur Fracture Etiology / Epidemiology / Natural History
- Pediatric Subtrochanteric fractures = femurs fractures occuring below the lesser trochanter within the proximal 10% of the femur.
- Occurs from high-energy injury.
Pediatric Subtrochanteric Femur Fracture Anatomy
- Proximal fragment is typically externally rotated and flexed due to the pull of the iliopsoas (Iliacus/ Psoas) and abducted by the short abductors inserting into the greater trochanter.
- Distal fragment is displaced medially by the adductor magnus.
Pediatric Subtrochanteric Femur Fracture Clinical Evaluation
- ATLS resuscitation. These can be high enegery injuries, assessment should begin with the A,B,C's.
- Leg is typically shortened and externally rotated.
- Document neurovascular exam.
Pediatric Subtrochanteric Femur Fracture Xray
- A/P pelvis, A/P and lateral of affected hip and femur.
Pediatric Subtrochanteric Femur Fracture Classification / Treatment
- Elastic nails (Pombo MW, JPO 2006;26:364).
- Treatment options: 2-3weeks in traction followed by spica cast, external fixation, elastic nails, ORIF.
- AO Classification AO Classification
Pediatric Subtrochanteric Femur Fracture Associated Injuries / Differential Diagnosis
- Femoral neck fracture
- Femoral shaft fracture
- Acetabular fracture
- Pelvic ring injury
Pediatric Subtrochanteric Femur Fracture Complications
- Malunion (coxa varus, shortening, rotational deformity)
- Leg length discrepancy
- Loss of fixation
- Nonuion
- Infection
- DVT / PE
Pediatric Subtrochanteric Femur Fracture Follow-up Care
- Post-op: WBAT if anatomic reduction and posteromedial bony contact achieved at surgery, otherwise NWB.
- 7-10 Days: Wound check
- 6 Weeks: Review xrays, advance weight bearing status when callus is evident on xrays.
- 3 Months: Review xrays, consider nail dynamization if fracture union is not evident.
- 6 Months: Assess status, review xrays, return to full duty if applicable.
- 1Yr: Review xrays, assess outcomes. Patients with often have femoral overgrowth.
Pediatric Subtrochanteric Femur Fracture References
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