Results and complications after delayed fixation of femoral neck fractures in pediatric patients

Abstract

Objective To evaluate the results and the factors affecting the development of avascular necrosis of the femoral head in children who underwent surgery for femoral neck fractures after a 24-hour delay.Methods We reviewed the results of 21 children (16 boys,5 girls; range 5 to 15 years with an average of 11 years) who were operated on after the first 24 hours for femoral neck fractures.By Delbet's classification,there was 2 cases of type Ⅰ,9 of type Ⅱ,8 of type Ⅲ and 3 of type Ⅳ.The mean duration from trauma to surgery was 14.8 days (range 3 to 90 days).Internal fixation was performed following closed (n =9) or open (n =13) reduction.The results were assessed using the Ratliff criteria at the end of a mean follow-up of 20 months (range 12 to 44 months).The patients were evaluated with respect to age,type of fracture,complications,treatment and avascular necrosis.Results The results were good in 18(82％),fair in 3 (14％),and poor in 1 patient (4％).The most frequent complication was avascular necrosis (18 ％),which was significantly related to poor outcome (P＜0.05).One (11％) hip developed avascular necrosis in closed reduction group and 3 (23％) hip developed avascular necrosis in open reduction group.There was no statistical difference between the two groups.No significant differences were found with regard to age and the type of fracture between patients with and without avascular necrosis (P＞0.05).Conclusions Outcomes of delayed in fracture fixation of the femoral neck are primarily affected by osteonecrosis of the femoral head.Closed reduction and internal fixation does seem to decrease the incidence of osteonecrosis. Key words: Femoral fractures;  Fracture fixation,internal;  Femur head necrosis