Management of subtrochanteric fractures of the femur in children.

We report the results of treatment in 99 children with subtrochanteric fractures of the femur. Late reviews of 60 of the 65 children treated with traction and then a hip spica after stabilization of the fracture by callus, and of 20 of the 22 treated with early closed reduction and a hip spica yielded 80% satisfactory outcomes. However, 27% of the fractures treated with early closed reduction required remanipulation. The satisfactory outcomes in the traction and delayed spica group would be increased to nearly 100% by using only skin traction, as persistent lengthening of the femur and pin-site pain, the main long-term complications, were the result of skeletal traction. Late review of 10 of the 12 children treated surgically showed 100% satisfactory medical outcomes but only 60% satisfactory patient-determined outcomes. Persistent pain in the thigh incision used for open reduction was the main cause of patient dissatisfaction.