Avascular Necrosis due to Delbet Type I Femoral Neck Fracture in an Adolescent: A Case Report and Literature Review

Abstract

Among all pediatric fractures, femoral neck fracture is an infrequent injury that occurs due to high-energy trauma. The high risk of complications, such as avascular necrosis (AVN), which is the most common and serious complication, coxa vara, nonunion, premature physeal closure and infections, turns this fracture into an orthopedic emergency and increases the need for early treatment and intervention. Among the classifications of femoral neck fractures, which are known as the Delbet classification, type 1 is the least common but with the highest risk of AVN. Therapeutic action for these patients is close or open reduction with internal fixation under general anesthesia, which according to the evidences, open reduction is a more successful method. Due to the high probability of complications and the urgent need for treatment of femoral neck fracture, early intervention and timely treatment should be performed. Here, we report a 14-year-old boy who was brought to the emergency department with a Delbet type 1B fracture of the left femoral neck with detached epiphyseal portion of the femoral head due to a car accident. After one failed attempt to closed reduction, open reduction and internal fixation with a posterolateral (Kocher) approach was performed under general anesthesia. The reduction was maintained with guide pins and fixed with cannulated screws. After 8 months of follow-up, AVN was noticed.