Fractures of the hip in children: a review of forty cases.

In a series of children's hip fracture seen over a 27-year-period, there were 39 patients (40 fractures) with a mean age of 8.9 years followed for an average 7 years. After an initial period of traction, 50% of the fractures were treated in a spica cast, 40% by internal fixation, and 10% by bed rest. Overall, there were 65% good results, 25% fair and 10% poor. All nondisplaced fractures were found to have a good result, while only one-half of displaced fractures were considered a good result. The complications were premature epiphyseal closure 23%, avascular necrosis 17%, coxa vara 12.5%, and nonunion 7.5%. Intertrochanteric fractures should be treated in traction followed by a spica cast. All other displaced fractures should be reduced and internally fixed. The hip joint capsule is opened in those transepiphyseal and transcervical fractures for which closed reduction has been unsuccessful. Spica casts are used to protect the fixation until roentgenograms show healing. Nondisplaced fractures may be treated non-operatively but must be watched closely for varus angulation. Threaded pins or lag screws are the devices of choice except in transepiphyseal fractures where smooth pins can be used to cross the physis. Nail-plates should be avoided.