You are here

Pediatric Subtrochanteric Femur Fracture S72.23XA 820.22

 

 

synonyms:

 

Pediatric Subtrochanteric Femur Fracture ICD-10

 

A- initial encounter for closed fracture

B- initial encounter for open fracture type I or II

C- initial encounter for open fracture type IIIA, IIIB, or IIIC

D- subsequent encounter for closed fracture with routine healing

E- subsequent encounter for open fracture type I or II with routine healing

F- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing

G- subsequent encounter for closed fracture with delayed healing

H- subsequent encounter for open fracture type I or II with delayed healing

J- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing

K- subsequent encounter for closed fracture with nonunion

M- subsequent encounter for open fracture type I or II with nonunion

N- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion

P- subsequent encounter for closed fracture with malunion

Q- subsequent encounter for open fracture type I or II with malunion

R- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion

S- sequela

Pediatric Subtrochanteric Femur Fracture ICD-9

Pediatric Subtrochanteric Femur Fracture Etiology / Epidemiology / Natural History

  • Pediatric Subtrochanteric fractures = femurs fractures occuring below the lesser trochanter within the proximal 10% of the femur.
  • Occurs from high-energy injury.

Pediatric Subtrochanteric Femur Fracture Anatomy

  • Proximal fragment is typically externally rotated and flexed due to the pull of the iliopsoas (Iliacus/ Psoas) and abducted by the short abductors inserting into the greater trochanter.
  • Distal fragment is displaced medially by the adductor magnus.

Pediatric Subtrochanteric Femur Fracture Clinical Evaluation

  • ATLS resuscitation. These can be high enegery injuries, assessment should begin with the A,B,C's.
  • Leg is typically shortened and externally rotated.
  • Document neurovascular exam.

Pediatric Subtrochanteric Femur Fracture Xray

  •  A/P pelvis, A/P and lateral of affected hip and femur.

Pediatric Subtrochanteric Femur Fracture Classification / Treatment

  • Elastic nails (Pombo MW, JPO 2006;26:364).
  • Treatment options: 2-3weeks in traction followed by spica cast, external fixation, elastic nails, ORIF.

Pediatric Subtrochanteric Femur Fracture Associated Injuries / Differential Diagnosis

  • Femoral neck fracture
  • Femoral shaft fracture
  • Acetabular fracture
  • Pelvic ring injury

Pediatric Subtrochanteric Femur Fracture Complications

  • Malunion (coxa varus, shortening, rotational deformity)
  • Leg length discrepancy
  • Loss of fixation
  • Nonuion
  • Infection
  • DVT / PE

Pediatric Subtrochanteric Femur Fracture Follow-up Care

  • Post-op: WBAT if anatomic reduction and posteromedial bony contact achieved at surgery, otherwise NWB.
  • 7-10 Days: Wound check
  • 6 Weeks: Review xrays, advance weight bearing status when callus is evident on xrays.
  • 3 Months: Review xrays, consider nail dynamization if fracture union is not evident.
  • 6 Months: Assess status, review xrays, return to full duty if applicable.
  • 1Yr: Review xrays.  
  • Post- assess outcomes. Patients with often have femoral overgrowth.

 

Pediatric Subtrochanteric Femur Fracture References

 

Disclaimer

The information on this website is intended for orthopaedic surgeons.  It is not intended for the general public. The information on this website may not be complete or accurate.  The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care".  While the information on this site is about health care issues and sports medicine, it is not medical advice. People seeking specific medical advice or assistance should contact a board certified physician.  See Site Terms / Full Disclaimer