Key result
Nonoperative treatment with traction is indicated for most pertrochanteric fractures in children and adolescents, while operative treatment may be necessary in polytrauma patients.
Pertrochanteric fractures in children are rare and generally managed nonoperatively with traction, though operative treatment may be needed in polytrauma patients.
Supports nonoperative traction for most cases; leaves open need for prospective data on polytrauma management.
Pertrochanteric fractures in children and adolescents are very rare, accounting for only 1% of these injuries. Most of the patients can be treated nonoperatively with traction, depending on age, in flexion or extension and abduction. Bryant's traction is preferable for very young children, whereas for slightly older children traction on the Weber rack is indicated. Very young children with a pertrochanteric fissure can be treated with bedrest alone. In older children and adolescents, the indicated fracture treatment is traction in extension and abduction. In polytrauma patients, operative treatment with cancellous bone screws or Kirschner wires and cerclage may be necessary. Conservative treatment with the aid of a hip spica is to be avoided, because it may cause serious complications. Fortunately, complications in fracture healing are rare in children and adolescents with pertrochanteric fractures; they are usually malunion or growth disturbances.
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Hoekstra et al. (1983) conducted a review in Pertrochanteric fractures. Traction was evaluated. Nonoperative treatment with traction is indicated for most pertrochanteric fractures in children and adolescents, while operative treatment may be necessary in polytrauma patients.
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