Abstract

Pediatric hip fractures are very rare and comprise only about 1 percent of all pediatric fractures [1]. Of all pediatric hip fractures rarest is the subtrochanteric hip fracture [2] for which no definite treatment guidelines are available. Different treatment options are used: skin traction, 90/90 skeletal traction, spica casting, cast bracing, internal fixation and external fixation. Patient age, weight, femoral canal size, fracture stability, associated injuries, and surgeon’s experience should all be considered when determining the best treatment option. Infants 0-6 months of age are well treated with a Pavlik harness. Children 6 months to 5 years of age should be treated with a hip spica cast, although internal fixation is a viable alternative if the fracture is unstable. But children more than 6 years is where the dilemma starts. There is no definite concensus on treatment and all have their own sets of complications. Unlike management of adult subtrochanteric fractures, internal fixation devices for the treatment are not so readily available for pediatric population. Pediatric DHS and Reconstruction plating [3] are some options that are available but both are lacking in stability as the fracture pattern is not addressed in both these options. Internal fixation device like TENS nailing is available but are applicable only to fractures below the subtrochanteric region. External fixation and casting are other methods but have their own set of complications and issues with social acceptance of these methods. We have used an adult Proximal humerus PHILOS plate to address a pediatric subtrochanteric fracture in a 10 year old adolescent girl child and found excellent results after a 3 month follow up and propose to add the same as a viable treatment option in management of such cases.

Keywords: Subtrochanteric fracture; Children; PHILOS plate