FRACTURES AND DISLOCATIONS Fractures of the proximal end of the femur are extremely rare in children and are usually due to severe trauma. Trauma may produce a displaced epiphysis or a fracture of the neck, trochanteric, or subtrochanteric region. Traumatic epiphyseal separation is probably less common than the previously mentioned fractures, but is more common than dislocation. The treatment of displaced fractures is anatomic reduction, followed by internal fixation surgically. Nondisplaced fractures of the intertrochanteric and subtrochanteric regions may be treated with skin or skeletal traction followed by abduction spica casting.35 There is a significant complication rate, especially avascular necrosis with transepiphyseal and transcervical (femoral neck) fractures.
Traumatic dislocations in children are rare, but are more common than hip fractures. They are more common in boys and more common between ages 2 and 5, and 11 and 15. The frequency of left versus right is equal, and bilateral dislocations are reportable. Posterior dislocations occur with an 80 to 85 percent frequency. The mechanism of injury and the clinical picture are similar to those seen in traumatic dislocation in the adult. The presence of an associated fracture is rare.
The treatment is closed reduction. Dislocation is an orthopedic emergency, and reductions should be done within six hours. Delay in reduction past 24 h is associated with a much higher incidence of complications.
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