engleski

Treatment of the proximal femur and neck fractures in children with healthy and pathological bone

Bone biology anatomy and morphology in children is unique. Geometry and morphology of the proximal femur in children are changing in the growing ages. In comparison with adult bone, in children there are changing pattern of the two growth cartilages ; starting with upright posture there is elongation of the femoral neck and finally femoral neck bone is stronger. There is special interest in paediatric and adolescent proximal femur and neck fractures because they are rare but in contrast its complications are numerous and frequent. Mechanism of injury is high energy forces across the joint ; e.g. motor vehicle accident or fall from the height. Current principles of treatment are anatomical reduction of fragments ; early surgical treatment in displaced fractures (within 24 hours) ; stable internal fixation ; joint decompression. Caveat: avascular necrosis (AVN) for up 18 month. Do MRI during follow-up, but do not cross the physis with implant and do not completely close the joint capsule. Regarding risk of AVN, the nature of the injury itself that determines the outcome. We do not have influence on degree of displacement, vascular injury and age of patient, but we have influence on delay of treatment because there is less AVN if treatment is performed within 6-8 hours.Technique of fixation is important and Intervention could reduce incidence of AVN after injury. In conclusion, hip fractures in children are rare (1% of adult fractures) and are prone to complications with AVN from 5 to 38% depending on type of fracture. This fracture needs emergency treatment with anatomic reduction and stable fixation are mandatory. In pathological bone there are two scenarios of problem. The first is bone lesion with no fracture when diagnosis is important question. One should carefully observe all details of lesion on the radiographs with emphasis on the size of the lesion and location of the lesion in the area of proximal femur. One should find answers to risk of fracture through lesion and If fracture through the lesion impending? Second scenario is lesion with the fracture and diagnosis is of utmost importance, again. One should question stability of the fracture and location of the lesion with regard to is there enough bone for purchase of implant? Important points are 1. The clinical picture together with images are the key factors in the diagnosis, although definitive diagnosis only by biopsy ; 2. Benign bone tumours do not spread to other parts of the body, but some can be locally aggressive. 3. The treatment should be addressed individually.

Fracture, children, proximal femur and neck

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