OrthoNet

Proximal Femur Fractures

There now appears to be a limited role for closed treatment and hip spica casting in any of these injuries

Delbert Classification (1907)
I - transepiphyseal fracture - AVN almost 100%
II - transcervical fracture - AVN 50-60%
III - basicervical fracture - AVN 30-40% - much higher than in adults
IV - intertrochanteric fracture

- current recommendations are to do capsulotomy and fixation

- watch for AVN and for early physeal arrest leading to coxa breva and GT overgrowth; LLD secondary to physeal arrest is usually not a huge problem.
- coxa vara is common if the reduction is fucked up.
- nonunion is rare, but can be treated with valgus subtrochanteric osteotomy.

Hip Dislocation

- closed reduction under general anesthetic
- CT to show concentricity of reduction and intra-articular loose body
- open reduction, if necessary is done through Kocher Langenbeck - head may be buttonholed through the capsule