Schmittenbecher Peter P
Kinderchirurgische Klinik, Städtisches Klinikum Karlsruhe gGmbH, Moltkestraße 90, 76133, Karlsruhe, Deutschland.
Chirurg. 2021 May;92(5):485-496. doi: 10.1007/s00104-020-01342-0. Epub 2021 Feb 2.
Femoral fractures in childhood are rare and are usually the result of severe trauma. Conservative treatment (overhead extension, hip spica cast) can be used in children up to 3 years of age and beyond that elastic stable intramedullary nailing (ESIN) is the method of choice. The prognosis is very good if the surgical technique is adequate. In adolescents > 50 kg in body weight solid nails implanted via the greater trochanter are an alternative (adolescent lateral femoral nail, ALFN). External fixators and plate osteosynthesis are indicated in special situations. Femoral neck fractures are very seldom seen in this age group. Besides Kirschner (K)-wires and screw osteosynthesis a special pediatric hip plate is available in this situation. In the distal metaphysis mostly stable fractures occur in disabled children, which can usually be treated conservatively. In addition, pathological fractures occur in juvenile bone cysts and complex injuries in adolescents, which need stabilization by descending ESIN or with plates. At the distal growth plate relevant growth disturbances are possible.
儿童股骨骨折较为罕见，通常是严重创伤所致。3岁及以下儿童可采用保守治疗（悬吊牵引、髋人字石膏固定），3岁以上则首选弹性稳定髓内钉固定（ESIN）。若手术技术得当，预后非常好。对于体重超过50千克的青少年，可经大转子植入实心髓内钉（青少年股骨外侧髓内钉，ALFN）作为替代方案。特殊情况下可使用外固定架和钢板内固定。该年龄组股骨颈骨折极为少见。除克氏（K）针和螺钉内固定外，这种情况下还有一种特殊的儿童髋部钢板可供使用。在干骺端，残疾儿童多发生稳定性骨折，通常可采用保守治疗。此外，青少年的骨囊肿可发生病理性骨折，以及复杂损伤，需要采用逆行ESIN或钢板进行固定。在远端生长板处，可能会出现相关的生长紊乱。
