A gentle attempt to perform a closed reduction is an appropriate first step after prompt diagnosis. If anatomic reduction is not possible via a closed approach, open reduction within 24 hours is necessary.
Causes / typical injury mechanism: Proximal femur fractures in children are rare injuries, representing less than 1% of pediatric fractures. These usually result from high-energy trauma, such as a motor vehicle crash, a fall from a height, or nonaccidental trauma in preschool-aged patients. Pathologic fractures due to tumors or metabolic bone disease are less common.
In the United States, suspicion of child abuse legally necessitates contacting Child Protective Services (CPS) and intervening to prevent further injury. The American Academy of Pediatrics recommends consulting a child abuse pediatrician if you need assistance in the evaluation or management of suspected child abuse.
Classic history and presentation: Severe pain in or near the affected hip and a shortened, externally rotated lower extremity following a high-velocity injury to a skeletally immature patient. Most patients will have concomitant injuries.
Prevalence:
- Age – Bimodal.
- Younger than 2-3 years from nonaccidental trauma.
- Peak incidence is between 10 and 13 years old from motor vehicle crashes.
- Sex / gender – Twice as common in males than females.
Grade / classification system: The Delbet classification system is most often used to describe pediatric proximal femur fractures.
- Type I fractures involve the physis (transepiphyseal separation)
- Type IA fractures are without dislocation
- Type IB fractures are dislocated
- Type II fractures are transcervical (through mid-portion of femoral neck)
- Type III fractures are basicervical (through base of femoral neck)
- Type IV fractures are intertrochanteric (between the greater and lesser trochanters)
