Pediatric emergency medicine trisk 3489 3489
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FIGURE 111.32 Avulsion fracture of the right ischial tuberosity in a 13-year-old girl (arrow ).
Injuries of the Hip and Proximal Femur
Goals of Treatment
Dislocations of the hip should be reduced in a timely manner, ideally within 6
hours of injury, with pre- and postreduction x-rays to identify any associated
avulsion fractures. Proximal femur fractures should have urgent orthopedic
consultation for reduction, as timing of surgical management (<24 hours) is
associated with decreasing the risk of avascular necrosis.
CLINICAL PEARLS AND PITFALLS
Hip dislocations should be reduced as soon as possible as the risk for
avascular necrosis of the femoral head increases with each hour of
delay.
The sciatic nerve is the most common neurologic injury associated with
hip dislocation.
Complications of proximal femur fractures include nonunion, malunion,
growth arrest, and avascular necrosis of the femoral head.
