MANAGEMENT OF SUBTROCHANTERIC FRACTURES IN SKELETALLY IMMATURE ADOLESCENTS

Abstract

Subtrochanteric femoral fractures are uncommon in children, consequently there are no good treatment guidelines in the literature. This series reviewed all subtrochanteric femur fractures in skeletally immature adolescents older than ten years treated at a pediatric trauma center. There were fifteen adolescents with open growth plates. Treatment was non-operative in four and operative in eleven. Each of the adolescents treated non-operatively developed an unsatisfactory result, while eight of the eleven who were treated operatively experienced a satisfactory result. These results suggest improved outcome with operative treatment in this patient population.

It was the purpose of this study to describe treatment options and make recommendations for management of subtrochanteric femur fractures among skeletally immature adolescents older than ten years of age.

This series consisted of a retrospective review of all cases of subtrochanteric fractures in adolescents with open growth plates. The outcome was classified on the basis of radiographic criteria.

There were fifteen adolescents with an average age of thirteen years and one month. The average length of follow-up was two years and nine months. Treatment was non-operative in four and operative in eleven, utilizing a variety of fixation devices. There was fracture union in each case, although there was one delayed union. Complications included limb length discrepancy in three, each of which were treated non-operatively, one transient peroneal nerve palsy and asymptomatic heterotopic ossification. One adolescent, treated with a rigid intramedullary rod, developed avascular necrosis of the femoral head. The result was unsatisfactory in each of the non-operative cases, while eight of the eleven treated operatively developed satisfactory results.

Children less than ten years of age may be treated non-operatively. However, in skeletally immature adolescents, operative treatment resulted in improved outcomes. Rigid intramedullary fixation is contraindicated in skeletally immature adolescents due to the risk of avascular necrosis of the femoral head.

This series is the first to emphasize treatment and make management recommendations regarding subtrochanteric fractures in this age group.

Internal fixation is more effective than non-operative treatment for subtrochanteric femur fractures in skeletally immature adolescents, however the ideal method of fixation requires further study.