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Hip fractures in children

Kimberly P Stone, MD, MS, MA
Klane White, MD
Section Editor
Richard G Bachur, MD
Deputy Editor
James F Wiley, II, MD, MPH


This topic will review issues related to hip fractures (proximal femur and femoral neck fractures) in children. Slipped capital femoral epiphysis (SCFE) and femoral shaft fractures in children are discussed separately. (See "Evaluation and management of slipped capital femoral epiphysis (SCFE)" and "Femoral shaft fractures in children".)


Pediatric hip fractures can be divided into four types as first described by Delbet (figure 1) [1-4] as follows:

Type I: Transepiphyseal – These are fractures through the proximal femoral physis, and represent Salter-Harris type I fractures of the proximal femur [3]. Subtypes are IA (without dislocation) and IB (with dislocation) (figure 1). These are the least common types of hip fracture in children, accounting for <10 percent of these fractures [1,3,5-7]. Transepiphyseal fractures occur more commonly in young children and infants. In neonates they are equivalent to "proximal femoral epiphysiolysis," resulting from difficult delivery [1,3]. These fractures are also associated with femoral head dislocations [8]. In children under two years of age, the presence of a transepiphyseal fracture should prompt an evaluation for nonaccidental trauma when a history of trauma is lacking or of insufficient force to explain the degree of injury.

Type II: Often identified as the most common type of pediatric hip fracture extends through the mid-portion of the femoral neck and is found in 40 to 50 percent of children [1,3,5-10].

Type III: Cervicotrochanteric – This fracture occurs through the base of the femoral neck and is seen in 25 to 35 percent of children with hip fractures [1,3,5-10].

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Literature review current through: Nov 2017. | This topic last updated: Jul 11, 2017.
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