Proximal femoral fractures in children: incidence, complications, and functional outcomes-a population-based study from Finland.

Abstract

Background and purpose:  Pediatric proximal femoral fractures are rare and frequently complicated fractures with avascular necrosis (AVN), nonunion, deformity, leg-length discrepancy (LLD), and premature physeal closure (PPC). Our aim was to describe the incidence, complications and functional outcomes.

Methods:  In this register-based study from a 10-year period (2014-2023) we identified 51 non-pathological proximal femoral fractures from the KIDS Fracture Tool database. Statistical yearbooks of Helsinki were utilized to estimate annual incidence. We used interviews and Oxford Hip Scores (OHS) for functional outcome assessment. If any symptom or functional deficit was described, or if Oxford Hip Score (OHS) was < 41, patients were also invited for clinical examination and radiography.

Results:  51 patients with a proximal femoral fracture (31 boys) were identified representing 0.2% (51/21,121) of all child fractures with a population-based annual incidence of 1.7/100,000 children. We interviewed 46/51 of the patients or their guardians via telephone. 6/46 were invited for clinical examination and radiography. Median follow-up of contacted patients was 4 (range 1-9.5) years. Complications occurred in 9/20 patients with collum and trochanteric fractures (pain from osteosynthesis 4, AVN 3, nonunion 1, coxa vara 1, LLD 1, PPC 0) and in 7/31 with subtrochanteric fractures (pain from osteosynthesis 5, misplaced pins 2, angular deformity 1, peri-implant fracture 1). All underwent reoperation. The median OHS was 48 (interquartile range 47-48) at last follow-up. Functional outcomes were impaired in 3 patients. All 3 had AVN.

Conclusion:  The incidence of non-pathological pediatric proximal femoral fractures is low. Despite frequent complications, impaired functional outcomes concerned only patients with AVN at median 4-year follow-up.