Management of subtrochanteric fractures in skeletally immature adolescents

Background: There have been no studies that have specifically looked at the management of subtrochanteric femoral fractures in skeletally immature adolescents. It was the purpose of this study to investigate the treatment of this injury in this unique patient population. Methods: A retrospective review of all subtrochanteric femoral fractures treated at a major pediatric trauma center since 1990 was performed. Results: There were 13 adolescents with an average age of 13 years and 6 months. The average length of follow-up was 2 years and 3 months. Eight of the 10 operatively treated patients had a satisfactory result, whereas the outcome was unsatisfactory in all three patients treated nonoperatively. Complications included three limb-length discrepancies, one case of avascular necrosis of the femoral head, one transient peroneal nerve palsy, and one case of asymptomatic heterotopic ossification. At the time of most recent follow up, all had returned to preinjury level of function. Conclusion: Operative treatment provided more satisfactory results than nonoperative methods.