Proximal Femur Fractures in Children: Enigmatic Injuries.

Proximal femoral fractures in the skeletally immature patient can be challenging for the orthopaedic surgeon to manage. This type of injury includes the femoral head/neck, intertrochanteric, and subtrochanteric fractures. The Delbet classification system historically describes all injuries in the pediatric proximal femur, except subtrochanteric fractures. Understanding the possible complications (coxa vara, osteonecrosis, premature physeal closure, nonunion) when managing these injuries can help with preoperative and intraoperative decision making. Although the understanding of proximal femur fractures has improved, many of the risk factors for poor outcomes in these injuries are not modifiable. Familiarity with the history, classification, complications, factors influencing the outcome, and management options available in 2018 will help improve the outcomes of pediatric proximal femur fractures.