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Fractures & Dislocations of the Paediatric Hip

  • Usually high energy
  • Many associated with other injury
  • AVN(Avascular Necrosis | Osteonecrosis)and Growth arrest are common
    • the physeal plate prevents blood crossing it until physeal closure
    • main supply is the lateral epiphyseal vessels, terminal of the medial femoral circumflex
    • If there is dislocation even higher incidence of avascular necrosis

Treatment

  • Treated as emergent within 12 hours
  • Factors affecting outcome – initail trauma, time to fixation
  • No evidence that capsulotomy to expel blood affects outcome

Classification

Delbet Classification of Paediatric Hip Fractures
Anatomic Location Rate of AVN
Transepiphyseal 80%
Transcervical  
Basicervical 30%
Intertrochanteric 10%

Treatment

  • Transepiphyseal
    • 50% with dislocation of the physis
    • 80% AVN
    • Treatment
      • young child < 18 months – closed reduction & cast
      • older child closed reduction & 2 smooth pins, + spica
  • Transcervical
    • Closed reduction & screws
    • If too small, smooth pins accros the physis & spica
    • If open reduction required – Watson Jones interval
  • Basicervical
    • Nondisplaced – spica
    • Displaced – 2 cancellous screws versus paediatric hip screw
    • AVN 30%
  • Intertrochanteric
    • AVN 0-10%
    • Traction 90-90
    • Versus hip screw

 

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