Delayed treatment of 51 pediatric displaced femoral neck fractures

Abstract

Objective To compare open versus closed reduction in treatment of children with displaced femoral neck fracture whose reduction is delayed by more than 24 hours. Methods We retrospectively reviewed 51 children who had been treated at our department for femoral neck fracture between May 2005 and May 2012 after their reduction had been delayed for more than 24 hours. They were 37 boys and 14 girls, 1.7 to 15.5 years of age (average, 9.1 years). According to Delbet's classification, 27 cases belonged to type Ⅱ, 18 to type Ⅲ, and 6 to type IV. Of them, 18 underwent closed reduction and 33 open reduction. Their complications were recorded in detail. Their therapeutic results were evaluated according to Ratliff's criteria and compared between the 2 methods of reduction. Results The 51 children were followed up for an average of 36.7 months (range, from 17 to 61 months). Anatomic reduction was achieved in 6 cases in the closed reduction group (33.3%) and 29 cases in the open reduction group (87.9%), respectively. All fractures healed after an average of 10.9 weeks (range, from 9 to 13 weeks), with one exception of nonunion in the closed reduction group. The incidence of femoral head necrosis in the closed reduction group (27.8%, 5/18) was significantly higher than that in the open reduction group (15.2%, 5/33) (P<0.05). According to the Ratliff's evaluation at the final follow-ups, the good to excellent rate in the closed reduction group (66.7%, 12/18) was significantly lower than that in the open reduction group (84.8%, 28/33) (P<0.05). Coxa vara occurred in 3 children in the closed reduction group but in none in the open reduction group. Conclusion Open reduction with internal fixation may lead to better outcomes than closed reduction in the treatment of children with displaced femoral neck fracture whose reduction is delayed by more than 24 hours, probably because open reduction can result in better reduction quality. Key words: Femoral neck fractures; Fracture fixation, internal; Children