Vynichakis Georgios, Angelis Stavros, Chandrinos Michail, Apostolopoulos Alexandros P, Bogris Elefterios, Mirtsios Hristos, Papapostolou Petros, Kasiaras Athanasios, Filippou Dimitrios K, Michelarakis John Ν
2nd Orthopaedic Department, General Children's Hospital, Athens, Greece; Panagiotis and Agliaia Kyriakou Childrens Hospital, Athens, Greece.
2nd Orthopaedic Department, General Children's Hospital, Athens, Greece; Orthopaedic and Trauma Department, Hellenic Red Cross Hospital, Athens, Greece.
J Long Term Eff Med Implants. 2019;29(2):91-99. doi: 10.1615/JLongTermEffMedImplants.2019031253.
Hip fractures are uncommon in childhood and adolescence. A high-energy injury is the most common cause. Low-energy trauma may result in a pathological hip fracture or stress fracture of the femoral neck, on the grounds of a preexisting skeletal disease, a tumor, or a tumor-like lesion. Surgical or conservative treatment may be provided based on underlying disease and/or age, Delbet and/or Colona classification, and displacement of the fracture. We present a case series of 13 children with pathological hip fracture. Mean age of patients was 7 years, and average follow-up was 3 years. There were types I and II, 3 type III, and 10 type IV fractures according to Delbet/Colona classification. Patients were treated conservatively, by open reduction and internal fixation or by minimally invasive surgery. In 11 children (84.5%), the outcome was satisfactory; one child (7.75%) presented with nonunion and refracture after minimally invasive surgery, and another (7.75%) presented with refracture after conservative treatment. Both patients were treated with open reduction and internal fixation. Pathological hip fractures are rare in children and should be treated properly. Surgical treatment with open reduction, internal fixation, and bone grafting is preferred in displaced fractures. In nondisplaced fractures, the choice between conservative and surgical treatment should be based on Delbet/Colona classification and patient profile.
髋部骨折在儿童和青少年时期并不常见。高能损伤是最常见的原因。低能量创伤可能由于先前存在的骨骼疾病、肿瘤或肿瘤样病变导致病理性髋部骨折或股骨颈应力性骨折。可根据潜在疾病和/或年龄、德尔贝（Delbet）和/或科洛纳（Colona）分类以及骨折移位情况提供手术或保守治疗。我们报告了一组13例病理性髋部骨折患儿的病例系列。患者的平均年龄为7岁，平均随访时间为3年。根据德尔贝/科洛纳分类，有I型和II型骨折3例，III型骨折3例，IV型骨折10例。患者接受了保守治疗、切开复位内固定或微创手术治疗。11名儿童（84.5%）的治疗结果令人满意；1名儿童（7.75%）在微创手术后出现骨不连和再骨折，另1名儿童（7.75%）在保守治疗后出现再骨折。两名患者均接受了切开复位内固定治疗。病理性髋部骨折在儿童中很少见，应进行适当治疗。对于移位骨折，首选切开复位、内固定和植骨的手术治疗。对于无移位骨折，保守治疗和手术治疗的选择应基于德尔贝/科洛纳分类和患者情况。
