Abstract
The aim of this retrospective study was to analyze the radiological and clinical results of pediatric femur neck fractures. This study included 39 children (mean age 11.1, range 4 to 16 years) who had a femur neck fracture and had at least one year of complete follow-up. The most common etiological factor was traffic accident and the most common associated skeletal injury was pelvis fracture. According to Delbet's classification system, there were no type I (transepiphyseal) fractures and 21 type II (transcervical), 14 type III (cervicotrochanteric), and four type IV (intertrochanteric) fractures. The mean follow-up was 3.4 (1-9.5) years. A satisfactory outcome according to Ratliff's radiological and clinical criteria was obtained in 28 (72%) hips. Avascular necrosis (AVN) of the femoral head was seen in 11 (28%) hips and the rate of satisfactory outcome was significantly higher in hips without AVN than in hips with AVN (P < 0.001). Transcervical fractures had the worst outcome (P = 0.014) and the highest rate of AVN (P = 0.077) when compared with cervicotrochanteric and intertrochanteric fractures. No significant correlation was found between both the outcome and development of AVN and age, gender, laterality, amount of fracture displacement, treatment time, and the type of reduction (open/closed) (P > 0.05). It has been concluded that the development of AVN primarily influences the outcome in pediatric femur neck fractures and that fracture type is essentially correlated with the development of AVN and outcome.
Highlights
Femur neck fractures constitutes less than 1% of the entire population of pediatric fractures
The only satisfactory outcome following avascular necrosis (AVN) due to femur neck fracture was observed in an 8-year-old girl having a type III AVN (Fig. 1)
The only unsatisfactory outcome without AVN was seen in a 14-year-old girl who had a deep wound infection, which would lead to a further hip arthrodesis
Summary
Femur neck fractures constitutes less than 1% of the entire population of pediatric fractures. We initially hypothesized that there should be some factors determining the clinical and radiographic outcomes in pediatric femur neck fractures. The aim of this retrospective study was to evaluate the clinical and radiological outcomes of the pediatric patients with femur neck fractures and to assess the effects of several preoperative, intraoperative, and postoperative factors, such as age, gender, laterality, fracture type, amount of fracture displacement, treatment time, open reduction allowing concurrent drainage of the intracapsular hematoma, and AVN on the clinical and radiological outcomes
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