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.
– 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