Late presentation Subtrochanteric femur fracture in 12 year old child

• Author Details:   
• Rajeev Shukla
• Agrawal Utkarsh
• Gurjar Abhishek
• Jain Ravikant

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Background: Paediatric sub trochanteric femoral fractures are rare injuries with having limited attention received in the available literature. Different treatment options have been used for the treatment of sub trochanteric femur fractures like skin traction, skeletal traction, spica casting, cast bracing and internal fixation. Methods of internal fixation include:  intramedullary nails and compression plating. This case report is about a 12 years old female child with late presentation of sub trochanteric femur fracture treated with Titanium Elastic Nailing system(TENS).
Method: A 12 years old female child presented to our Emergency with chief complaint of pain in right thigh along with inability to bear weight on her right lower limb following history of road traffic accident around 14 days back. On presentation her right lower limb was in abduction and external rotation and hip in flexion. Previous X-rays revealed undisplaced fracture sub trochanteric femur. She was managed conservatively on skin traction for 14 days at some other hospital before presenting to us.  So  repeat  x-rays  were  done  which  revealed  that  fracture  was  displaced.  So  operative  intervention  planned  and  the  fracture  was  fixed  with  three  TENS  Nails.
Results: Follow-up  x-rays  after  2  months  showed  good  fracture  healing  and  after  1  year  showed  complete  union  with  pain  free  range  of  motion  at  hip  and  knee  joints  and  no  residual  deformity.
Conclusion: Internal  fixation  with  flexible  intramedullary  nailing  appears  as  an  excellent  treatment  option  for  sub trochanteric  femoral  fractures  in  children  especially  in  age  group  of  6-12  years.

Keywords:  Sub trochanteric  femur  fracture,  late  presentation,  paediatric  age  group,  Closed  reduction  and  internal  fixation,  TENS