External fixation of paediatric subtrochanteric fractures using calcar rather than neck pins

Abstract

Subtrochanteric femoral fractures in children are uncommon and have received limited attention in the literature. Its treatment is controversial, and different options are available: traction, spica casting, internal fixation and external fixation. The aim of this study is to present our results with external fixation of subtrochanteric femoral fractures in children using Ilizarov frame. Between January 2012 and January 2014, 14 patients with closed subtrochanteric femoral fractures were treated in Cairo University School of Medicine Teaching Hospital. The average age at the time of injury was 6.4 years (range 3.8–11.5 years). Pathological fractures and fractures associated with neuromuscular diseases were excluded from this study. Two patients were multiply injured with abdominal injuries (as ruptured spleen). In all cases, a low profile Ilizarov frame was inserted using two half pins inserted proximally from greater to lesser trochanters parallel to the hip joint orientation line (line between tip of greater trochanter and femoral head centre) and secured to an arch, and another three half pins were inserted distally perpendicular to the femoral shaft and secured to an arch that was connected by three rods to the proximal arch. No post-operative spica was used. Average follow-up was 18 months (range 12–36 months). All fractures united with anatomical alignment within an average of 8 weeks (range 6–12 weeks). There were no deep infections and no significant limb length discrepancies. At the latest follow-up, no patient had any restriction of activities. External fixation with a low profile Ilizarov frame appears as a good treatment option for subtrochanteric femoral fractures in children. Level of evidence: Level IV.