Ipsilateral Femoral Neck and Shaft Femur Fracture in a Child: Nonoperative Management

Concomitant ipsilateral fractures of the neck and shaft of femur are a rare occurrence in childhood. Only 14 cases have been reported to date, the most common fracture pattern being Delbet Type III and a spiral fracture of midshaft femur. A four-year-old boy presented with closed fracture shaft femur and chest trauma (2-8th rib fractures right side with underlying haemopneumothorax), fracture neck femur was incidentally detected on pelvic radiographs. Initially, he was managed according to ATLS protocols, surgical management of lower limb was deferred till vitals stabilised. Later child was managed nonoperatively in view of persistent poor chest condition with one and half hip spica cast. Successful clinic-radiological union was noted at 24 months. We should have a high index of suspicion for proximal femur fractures especially in a child with multiple organ injuries.