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Pediatric Subtrochanteric Femur Fracture S72.23XA 820.22

 

 

synonyms:

 

Pediatric Subtrochanteric Femur Fracture ICD-10

 

A- initial encounter for closed fracture

B- initial encounter for open fracture type I or II

C- initial encounter for open fracture type IIIA, IIIB, or IIIC

D- subsequent encounter for closed fracture with routine healing

E- subsequent encounter for open fracture type I or II with routine healing

F- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing

G- subsequent encounter for closed fracture with delayed healing

H- subsequent encounter for open fracture type I or II with delayed healing

J- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing

K- subsequent encounter for closed fracture with nonunion

M- subsequent encounter for open fracture type I or II with nonunion

N- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion

P- subsequent encounter for closed fracture with malunion

Q- subsequent encounter for open fracture type I or II with malunion

R- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion

S- sequela

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.

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.  
  • Post- assess outcomes. Patients with often have femoral overgrowth.

 

Pediatric Subtrochanteric Femur Fracture References