Schraubenosteosynthese proximaler Femurfrakturen im Kindesalter

ObjectiveOptimal reposition and stable fixation of M/1 and M/2 fractures are necessary. Careful operation and urgent surgery prevent complications.IndicationsM/1 and M/2 fractures of the proximal femur in children > 4 years.ContraindicationsE/1 fractures are fixed with Kirschner wires.M/3 fractures are fixed with elastic stable intramedullary nailing.Fractures up to the age of 4 are fixed with Kirschner wires.Surgical TechniqueSurgical approach via a lateral incision. Anatomic fixation of the fracture with two to three cannulated screws.Postoperative ManagementNo weight bearing during the first 4-6 weeks. Physiotherapy is optional. Magnetic resonance imaging at least 1 year after the fracture or immediately in case of problems to control the vascular situation of the femoral head.ResultsDue to the rarity of these fractures, only few results from large series have been published. M/1 fractures show a higher complication rate than M/2 fractures. The risk of avascular necrosis has to be estimated at up to 40%.