Bone Abstracts

Hip fractures in children are extremely rare and account for less than 1% of all fractures in children. Most orthopaedic surgeons will treat only a few such fractures in a lifetime. They are associated with high complication rate because the vascular and osseous anatomy of the child’s proximal femur is vulnerable to injury. Knowledge of the blood supply to the immature proximal femoral epiphysis is necessary to adequately manage these injuries. Hip pain in children is a diagnostic challenge for every physician due to the variety of possible causes from mild transient to potentially life threatening conditions.

19 months old boy was brought to the hospital by his parents after sustaining a fall at home. He was unable to weight bear on his left leg. Detailed history revealed that the boy has fallen whilst playing from his standard size bed and there were no underlying medical conditions.

Clinically the patient was afebrile, oriented with no obvious deformity swelling or bruising in his left leg. Passive movements of left hip were painful. Plain radiographs of left hip demonstrated some radiolucency around lesser trochanter on AP and in the metaphyseal region on LAT views. Blood tests were normal and the diagnosis of undisplaced intertrochateric fracture was made. Patient was treated with rest, pain control and no cast immobilisation. Weekly radiographs to monitor the fracture position revealed callus formation around the fracture site at 6 weeks.

The patient made full recovery and no complications were encountered during the next 2 years.

The majority but not all of the hip fractures in children are caused by severe, high-energy trauma. Not all fractures can be detected on plain radiographs early. Undisplaced fractures may appear as faint radiolucencies. Special studies may be required to reveal an occult fracture. In a patient with posttraumatic hip pain without evidence of a fracture, other diagnoses must be considered including synovitis, haemarthrosis, infection, child abuse, stress fracture. Patients should be followed with plain radiographs for at least 2 years after fracture to rule out late onset of AVN.

Disclosure: The authors declared no competing interests.