Authors of section

Authors

Andrew Howard, James Hunter, Theddy Slongo

Executive Editor

Fergal Monsell

General Editor

Chris Colton

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Nonoperative treatment

1. Nonoperative treatment

Treatment

It is important to avoid active contraction and passive movement of the corresponding muscles. Therefore, good instructions from the surgeon and/or physiotherapist are helpful.

Crutch walking, supervised by a physiotherapist, should be advised for 3-4 weeks.

Note: Toe-touch weight bearing stresses the hip and proximal femur less than non-weight bearing.

31 m 7

Follow up

Decreasing pain is a good indicator of healing, and clinical and radiological surveillance becomes generally unnecessary.

2. Protected weight bearing

Introduction

After surgical stabilization, the construct should be sufficiently robust to allow protected weight bearing. Smaller children may not be able to comply with this and may need immobilization.

Infection

See the additional material on postoperative infection.

Mechanics

Forces through the hip are less with toe-touch weight bearing than with no weight bearing. Therefore, toe-touch is normally recommended for initial mobilization. This needs to be taught to children by a physiotherapist.


in situ fixation with k wires or screws

Range of movement

Range-of-movement exercises should start in the immediate postoperative period to prevent stiffness. Surgeons should indicate if any extremes of movement are forbidden.

Weight bearing

Having started with toe-touch weight bearing, children progress to partial weight bearing and then to full weight bearing according to their age and the predicted rate of healing of their fracture.
Even older adolescents should be fully weight bearing without aids at three months.

Sports

Swimming can be allowed as soon as partial weight bearing is permitted.
Contact sports should be avoided for at least six months.

Follow-up x-rays

X-rays are generally taken immediately after the surgery and at 6 and 12 weeks.

Implant removal

Implants that cross the physis should be removed if there is significant growth remaining. The fracture should be healed and consolidated prior to removal (see Healing times).

Implants in young children should always be removed to prevent them from being covered by bony overgrowth.

Implant removal is not compulsory in adolescents.