Surgical treatment of pathological subtrochanteric fractures due to benign lesions in children and adolescents.

Twelve children and adolescents with pathological subtrochanteric fractures due to benign tumors or tumorlike lesions were treated by curettage, autologous cancellous bone graft, and internal fixation. The healing of the lesion and the fracture in nine patients was without complications. In the remaining three, the healing was complicated. In one, with nonunion and shortening due to 35 degrees varus deformity following conservative treatment, a 1-cm shortening due to 15 degrees varus deformity remained after surgery. In the same patient, a small recurrence was curetted when removing the plate and the screws. In the second, a stress fracture with varus deformity and shortening followed surgical treatment. These were corrected by valgus osteotomy. In both patients the final result was good. In the third, a femoral head collapse occurred. It was due to a lesion in the head that was overlooked on the initial roentgenogram. Although the fracture and the lesion were healed, the final result was poor. It was concluded that internal fixation of these fractures allows thorough curettage and bone grafting and results in the least amount of immobilization and the most rapid resolution of the lesion and the fracture.