[Screw osteosynthesis of proximal femur fractures in children].

OBJECTIVE: Optimal reposition and stable fixation of M/1 and M/2 fractures are necessary. Careful operation and urgent surgery prevent complications. INDICATIONS: M/1 and M/2 fractures of the proximal femur in children > 4 years. CONTRAINDICATIONS: E/1 fractures are fixed with Kirschner wires. M/3 fractures are fixed with elastic stable intramedullary nailing. Fractures up to the age of 4 are fixed with Kirschner wires. SURGICAL TECHNIQUE: Surgical approach via a lateral incision. Anatomic fixation of the fracture with two to three cannulated screws. POSTOPERATIVE MANAGEMENT: No weight bearing during the first 4-6 weeks. Physiotherapy is optional. Magnetic resonance imaging at least 1 year after the fracture or immediately in case of problems to control the vascular situation of the femoral head.
RESULTS: Due to the rarity of these fractures, only few results from large series have been published. M/1 fractures show a higher complication rate than M/2 fractures. The risk of avascular necrosis has to be estimated at up to 40%.