Treatment of femoral neck fractures in pediatric patients.

Abstract

Objective To investigate the therapeutic results of femoral neck fractures in pediatric patients in our center and review the literature. Methods Authors conducted a computerized search of med-ical records to identify all children with femoral neck fractures treated at our institution from January 1986 to December 2007. Records were reviewed to determine injury mechanism, fracture type (Delbet's classification: type Ⅰ to Ⅳ), displacement, age, treatment and complication. Twenty-three patients with a mean age of 12.8 years (range, 3-16 years) with femoral neck fractures were identified and 3 cases with cerebral palsy were excluded. There were 13 male patients and 10 female patients. Nineteen cases underwent operation, includ-ing closed reduction for 15 cases, and open reduction for other 4 cases. Four cases were treated conservation. The mean follow-up was 4 years (range, 1.1-11 years). We studied timing of surgery, type of fixation, and quality of reduction with respect to the primary outcome measure-radiographic evidence of union and avascu-lar necrosis. The BMI and BMD data of latest 3 patients were obtained due to specially trivial injury mecha-nism. Results Eighteen of 19 operated cases have satisfied healing of fracture in good to excellent posi-tions. One patient had Haidukewych classification of fair reduction with delayed union and required hip screw revision and bone grafting. One had coxa varus, one had coxa valgus. Four patients were treated more than 24 hours after injury, including the patient who had delayed union. The mean time to fixation for the remaining patients was 11.2 hours after injury. The BMI and BMD data of 3 patients were abnormal when compared with children of the same age group. Conclusion The study shows that closed or open reduction, decompression and cannulated screw stable internal fixation for femoral neck fractures in children should be a standard treatment which leads to satisfactory results without occurrence of avascular necrosis. Key words: Child; Femoral neck fractures; Femur head necrosis