Subtrochanteric Femur Fractures in Children

Pediatric subtrochanteric femur fractures are a challenging subset of fractures to treat, with a relative paucity of literature-based evidence to support specific algorithmic approaches. These fractures are rare, and there is no clear consensus among authors on the definition of a subtrochanteric femur fracture in children. Patient age, weight, femoral canal size, fracture stability, associated injuries, and surgeon experience should all be considered when determining the best treatment option. Infants 0–6 months of age are well treated with a Pavlik harness. Children 6 months to 5 years of age should be treated with a hip spica t, although internal fixation is a viable alternative if the fracture is unstable. Flexible intramedullary nails, open plating, and submuscular plating are all successful treatment options in children 5–11 years of age, depending on the fracture pattern. Finally, children aged 11 years to skeletal maturity are well treated with rigid intramedullary nailing using a lateral trochanteric entry site. While these overall principles largely mirror trends currently applied for treatment of femoral shaft fractures in children, subtrochanteric fractures are frequently more prone toward displacement, due to the strong, divergent pull of muscular attachments in the peritrochanteric region. Therefore, consideration should be given toward selection of age-based treatment approaches more likely to ensure stability. All treatment methods have associated complications, and these should be discussed with the patient and family during the informed consent process.