{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T08:36:42Z","timestamp":1786696602239,"version":"build-2736575974"},"reference-count":26,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ActaO"],"abstract":"<jats:p>Background and purpose:\u00a0Pediatric proximal femoral fractures are rare and frequently complicated fractures with avascular necrosis (AVN), nonunion, deformity, leg-length discrepancy (LLD), and premature physeal closure (PPC). Our aim was to describe the incidence, complications and functional outcomes.Methods:\u00a0In this register-based study from a 10-year period (2014\u20132023) we identified 51 non-pathological proximal femoral fractures from the KIDS Fracture Tool database. Statistical yearbooks of Helsinki were utilized to estimate annual incidence. We used interviews and Oxford Hip Scores (OHS) for functional outcome assessment. If any symptom or functional deficit was described, or if Oxford Hip Score (OHS) was &lt; 41, patients were also invited for clinical examination and radiography.Results:\u00a051 patients with a proximal femoral fracture (31 boys) were identified representing 0.2% (51\/21,121) of all child fractures with a population-based annual incidence of 1.7\/100,000 children. We interviewed 46\/51 of the patients or their guardians via telephone. 6\/46 were invited for clinical examination and radiography. Median follow-up of contacted patients was 4 (range 1\u20139.5) years. Complications occurred in 9\/20 patients with collum and trochanteric fractures (pain from osteosynthesis 4, AVN 3, nonunion 1, coxa vara 1, LLD 1, PPC 0) and in 7\/31 with subtrochanteric fractures (pain from osteosynthesis 5, misplaced pins 2, angular deformity 1, peri-implant fracture 1). All underwent reoperation. The median OHS was 48 (interquartile range 47\u201348) at last follow-up. Functional outcomes were impaired in 3 patients. All 3 had AVN.Conclusion:\u00a0The incidence of non-pathological pediatric proximal femoral fractures is low. Despite frequent complications, impaired functional outcomes concerned only patients with AVN at median 4-year follow-up.<\/jats:p>","DOI":"10.2340\/17453674.2025.44752","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T06:41:08Z","timestamp":1759300868000},"source":"Crossref","is-referenced-by-count":4,"title":["Proximal femoral fractures in children: incidence, complications, and functional outcomes\u2014a population-based study from Finland"],"prefix":"10.2340","volume":"96","author":[{"given":"Sini-Tuuli","family":"Koivisto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5200-3279","authenticated-orcid":false,"given":"Ilkka","family":"Helenius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antti","family":"Stenroos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juho-Antti","family":"Ahola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3925-2446","authenticated-orcid":false,"given":"Topi","family":"Laaksonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"key":"128304","unstructured":"Rockwood C A, Beaty J H, Kasser J R. Rockwood and Wilkins\u2019 fractures in children. 7th ed. Philadelphia: Wolters Kluwer\/Lippincott, Williams & Wilkins; 2010, xiii, 1076 p."},{"key":"128305","doi-asserted-by":"crossref","unstructured":"Salonen A, Laitakari E, Berg H E, Fell\u00e4nder-Tsai L, Mattila V M, Huttunen T T. Incidence of femoral fractures in children and adolescents in Finland and Sweden between 1998 and 2016: a binational population-based study. Scand J Surg 2022; 111(1): 14574969221083133. doi: 10.1177\/14574969221083133.","DOI":"10.1177\/14574969221083133"},{"key":"128306","doi-asserted-by":"crossref","unstructured":"Engstr\u00f6m Z, Wolf O, Hailer Y D. Epidemiology of pediatric femur fractures in children: the Swedish Fracture Register. BMC Musculoskelet Disord 2020; 21(1): 796. doi: 10.1186\/s12891-020-03796-z.","DOI":"10.1186\/s12891-020-03796-z"},{"key":"128307","doi-asserted-by":"crossref","unstructured":"Lim E J, Kim B S, Kim M, Shon H C, Kim C H. Open reduction versus closed reduction in internal fixation of displaced femoral neck fracture in children: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18(1): 49. doi: 10.1186\/s13018-023-03525-x.","DOI":"10.1186\/s13018-023-03525-x"},{"key":"128308","doi-asserted-by":"crossref","unstructured":"Zhang Y, Xue Y, Zhao M, Chen X, Gao Q. Titanium elastic nails vs locking plate in pediatric subtrochanteric femur fractures: a systematic review and meta-analysis. Front Pediatr 2023; 11: 1114265. doi: 10.3389\/fped.2023.1114265.","DOI":"10.3389\/fped.2023.1114265"},{"key":"128309","doi-asserted-by":"crossref","unstructured":"Yeranosian M, Horneff J G, Baldwin K, Hosalkar H S. Factors affecting the outcome of fractures of the femoral neck in children and adolescents: a systematic review. Bone Joint J 2013; 95-B(1): 135-42. doi: 10.1302\/0301-620X.95B1.30161.","DOI":"10.1302\/0301-620X.95B1.30161"},{"key":"128310","doi-asserted-by":"crossref","unstructured":"Ratliff A H. Fractures of the neck of the femur in children. J Bone Joint Surg Br 1962; 44-B: 528-42. doi: 10.1302\/0301-620X.44B3.528.","DOI":"10.1302\/0301-620X.44B3.528"},{"key":"128311","doi-asserted-by":"crossref","unstructured":"Flynn J M, Hresko T, Reynolds R A, Blasier R D, Davidson R, Kasser J. Titanium elastic nails for pediatric femur fractures: a multicenter study of early results with analysis of complications. J Pediatr Orthop 2001; 21(1): 4-8. doi: 10.1097\/00004694-200101000-00003.","DOI":"10.1097\/01241398-200101000-00003"},{"key":"128312","doi-asserted-by":"crossref","unstructured":"Li Y, Heyworth B E, Glotzbecker M, Seeley M, Suppan C A, Gagnier J, et al. Comparison of titanium elastic nail and plate fixation of pediatric subtrochanteric femur fractures. J Pediatr Orthop 2013; 33(3): 232-8. doi: 10.1097\/BPO.0b013e318288b496.","DOI":"10.1097\/BPO.0b013e318288b496"},{"key":"128313","doi-asserted-by":"crossref","unstructured":"Eberl R, Singer G, Ferlic P, Weinberg A M, Hoellwarth M E. Post-traumatic coxa vara in children following screw fixation of the femoral neck. Acta Orthop 2010; 81(4): 442-5. doi: 10.3109\/17453674.2010.501744.","DOI":"10.3109\/17453674.2010.501744"},{"key":"128314","doi-asserted-by":"crossref","unstructured":"Pombo M W, Shilt J S. The definition and treatment of pediatric subtrochanteric femur fractures with titanium elastic nails. J Pediatr Orthop 2006; 26(3): 364-70. doi: 10.1097\/01.bpo.0000203005.50906.41.","DOI":"10.1097\/01.bpo.0000203005.50906.41"},{"key":"128315","doi-asserted-by":"crossref","unstructured":"von Elm E, Altman D G, Egger M, Pocock SJ, Gotzsche P C, Vandenbroucke J P, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370(9596): 1453-7. doi: 10.1016\/S0140-6736(07)61602-X.","DOI":"10.1016\/S0140-6736(07)61602-X"},{"key":"128316","doi-asserted-by":"crossref","unstructured":"Pakarinen O, Ahonen M, Grahn P, Helenius I, Laaksonen T. Refractures in children. J Bone Joint Surg Am 2025; 107(9): e40. doi: 10.2106\/JBJS.24.01014.","DOI":"10.2106\/JBJS.24.01014"},{"key":"128317","unstructured":"City of Helsinki Executive Office, Urban Research and Statistics. Statistical Yearbook of Helsinki 2019. https:\/\/www.hel.fi\/hel2\/tietokeskus\/julkaisut\/pdf\/20_03_10_Vuosikirjaenglanti2019.pdf [Context Link]. 2014\u20132023 (accessed 2024, Oct 12)."},{"key":"128318","doi-asserted-by":"crossref","unstructured":"Colonna P C. Fracture of the neck of the femur in childhood: a report of six cases. 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J Bone Joint Surg Br 1996; 78(2): 185-90.","DOI":"10.1302\/0301-620X.78B2.0780185"},{"key":"128322","doi-asserted-by":"crossref","unstructured":"Kalairajah Y, Azurza K, Hulme C, Molloy S, Drabu K J. Health outcome measures in the evaluation of total hip arthroplasties: a comparison between the Harris hip score and the Oxford hip score. J Arthroplasty 2005; 20(8): 1037-41. doi: 10.1016\/j.arth.2005.04.017.","DOI":"10.1016\/j.arth.2005.04.017"},{"key":"128323","doi-asserted-by":"crossref","unstructured":"Soylemez M S, Bingol I, Yasar N E, Dumlupinar E, Ayvali M O, Ata N, et al. Epidemiology and demographics of pediatric proximal femur fractures in T\u00fcrkiye: results from a government-based health registry. J Pediatr Orthop B 2024; 33(5): 443-51. doi: 10.1097\/BPB.0000000000001127.","DOI":"10.1097\/BPB.0000000000001127"},{"key":"128324","doi-asserted-by":"crossref","unstructured":"AlKhatib N, Younis M H, Hegazy A, Ibrahim T. Early versus late treatment of paediatric femoral neck fractures: a systematic review and meta-analysis. Int Orthop 2019; 43(3): 677-85. doi: 10.1007\/s00264-018-3998-4.","DOI":"10.1007\/s00264-018-3998-4"},{"key":"128325","doi-asserted-by":"crossref","unstructured":"Togrul E, Bayram H, Gulsen M, Kalaci A, Ozbarlas S. Fractures of the femoral neck in children: long-term follow-up in 62 hip fractures. Injury 2005; 36(1): 123-30. doi: 10.1016\/j.injury.2004.04.010.","DOI":"10.1016\/j.injury.2004.04.010"},{"key":"128326","doi-asserted-by":"crossref","unstructured":"Wright J G, Wang E E L, Owen J L, Stephens D, Graham H K, Hanlon M, et al. Treatments for paediatric femoral fractures: a randomised trial. Lancet 2005; 365(9465): 1153-8. doi: 10.1016\/S0140-6736(05)71878-X.","DOI":"10.1016\/S0140-6736(05)71878-X"},{"key":"128327","doi-asserted-by":"crossref","unstructured":"Saarinen A, Pakarinen O, Vaajala M, Liukkonen R, Ponkilainen V, Kuitunen I, et al. 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