[Treatment results and indications for surgery in subtrochanteric femur fractures during growth]

Abstract

A series of 29 subtrochanteric femoral fractures in children and adolescents treated during the last twenty years is presented. Primary osteosynthesis was done in five, secondary osteosynthesis in eleven patients. Ten patients were treated by an unilateral external fixator, two by a DC-plate, two by intramedullary nails, one by a Rushpin and one by cerclage wires. There were no deep infections. 13 patients were treated conservatively. Axial deviations resulted from conservative therapy in 9 of 11 patients, from osteosynthesis in one of 15 patients. One third of both series showed rotatory malalignment. Spontaneous corrections of axial deviations during growth can only be expected in small children to a small amount. In the average, operatively treated children had a positive leg length difference of one to two centimeters, whereas conservative treatment mostly resulted in equal leg lengths, but few patients showed differences from -4cm to +1 cm. Rotation and leg length seem to be more important for the clinical outcome than axial deviations of less than 20 degrees. Except in cases of severe concomitant injuries subtrochanteric fractures of the femur do not present an indication for primary osteosynthesis. If fracture reduction is not achieved by conservative means during the first four days osteosynthesis by DC-plates is recommended.