Fractures of the hip in childhood.

Twenty hip fractures in 19 children aged 2 1/2 to 18 were analyzed in a ten-year retrospective review at the University of Alabama Hospitals in Birmingham, Ala. There was one epiphyseal, one intertrochanteric, 4 subtrochanteric, and 14 intracapsular fractures. The mechanism of injury was usually severe trauma with 31% of the patients sustaining other associated major injuries. Avascular necrosis occurred in three intracapsular fractures (23%), all seemingly related to inadequate internal fixation. Coxa vara occurred in 30% of the patients; all were treated by closed methods, and delayed union and nonunion occurred in 10% of the series. Nine patients developed discrepancies of limb length between 1/2 and 13/4 inches. It was thought that intracapsular fractures should be treated with prompt open reduction and internal fixation with multiple pins; whereas, extracapsular fractures may be treated by either open or closed methods.