Complications Of Femoral Neck Fractures Research Articles

Correlation between combined deflection angle classification adduction typing and complications after internal fixation of adduction femoral neck fracture

To analyze the correlation between postoperative complications and combined deflection angle classification adduction type (CDAC-ADT) of femoral neck fractures after cannulated screw internal fixation. The clinical data of 121 patients with CDAC-ADT femoral neck fracture admitted between January 2018 and December 2021 and met the selected criteria were retrospectively analyzed. There were 69 males and 52 females, the age ranged from 19 to 79 years (mean, 48.1 years). The causes of injury included 52 cases of traffic accident, 24 cases of falling from height, and 45 cases of fall. The time from injury to operation ranged from 2 to 12 days, with an average of 6.0 days. Among them, there were 18 cases of CDAC-ADT type Ⅰ, 46 cases of type Ⅱ, and 57 cases of type Ⅲ; 6 cases of Garden type Ⅱ, 103 cases of type Ⅲ, and 12 cases of type Ⅳ; and according to the location of the fracture line, there were 26 cases of subcapitate type, 88 cases of transcervical type, and 7 cases of basal type. All patients were treated with cannulated screw internal fixation. The occurrence of complications (including internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head) was recorded, and the correlation between complications and CDAC-ADT typing, Garden typing, and fracture line location were analyzed. The patients were followed up 8-44 months, with a mean of 24.9 months. There were 10 cases of internal fixation failure, 7 cases of fracture nonunion, and 30 cases of osteonecrosis of the femoral head after operation. Correlation analysis showed that patients' CDAC-ADT typing was significantly correlated with the overall incidence of complication and the incidence of internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head ( P<0.05), and the Pearson coefficient of contingency were 0.435, 0.251, 0.254, and 0.241, respectively. Garden typing did not correlate with the overall incidence of complication and the incidence of internal fixation failure and fracture nonunion ( P>0.05), but correlated with the incidence of osteonecrosis of the femoral head ( P<0.05), and the Pearson coefficient of contingency was 0.251. Fracture line position typing had no correlation with the overall incidence of complication and the incidence of internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head ( P>0.05). CDAC-ADT typing has obvious correlation with postoperative complications of femoral neck fracture and can be used to predict complications of femoral neck fracture.

Postoperative clinical outcome and complications of combined cannulated cancellous screw with Kirschner wire in adolescent femoral neck fractures.

Fractures of the femoral neck account for less than 1% of pediatric and adolescent fractures. Due to the high incidence of complications, and the age of the patients, the choice of fixation approach remains controversial among orthopedic surgeons. This study aimed to evaluate the postoperative outcomes and complications of femoral neck fracture in adolescents with open physis, following transphyseal fixation using a combined cannulated cancellous screw and Kirschner wire fixation. Data of 19 patients aged between 12 and 19 years from January 2010 to January 2021 were retrospectively studied. The follow-up period was 1-11 years (5.83 ± 3.76 years). The variables of interest including demographic and clinical variables [age, BMI, gender, side of injury, fracture classification, operation time, time to surgery, and length of hospital stay (LOS)], postoperative outcomes, and complications (fracture healing time, nonunion, coxa vara, osteoarthritis, avascular necrosis, screw loosening, and femoral shortening) were analyzed. The assessment of the hip function was done on the final follow-up using the Ratliff scoring system. There was a male predominance of 76%; the mean age was 16.14 ± 1.57 years and the most frequent mechanism of injury was fall from a height. Delbet type II and III were the most encountered. The mean intraoperative time was 54.71 ± 7.85 min, the LOS was 8.34 ± 1.81days, and the time to surgery was 2.60 ± 1.16 days; the fracture healing time was 3.31 ± 1.04 months. The postoperative complications encountered were coxa vara osteoarthritis, spontaneous dislocation, and neck shortening. Clinical assessment revealed good results in 89% of patients and fair results in 11% of patients. Transphyseal fixation using cannulated cancellous screw combined with Kirschner wire in our patients provided acceptable results. Thus, this approach can be a viable alternative in the management of adolescent femoral neck fracture with open physis.

Valgus Osteotomy for Non-Union Fracture Neck of Femur in a Child: A Case Report

Paediatric neck of femur fractures is rare and incorporates less than 1% of all the paediatric fractures. Complications of femoral neck fractures in children includes necrosis (AVN) of femoral head, non-union and premature closure of the proximal femoral physis— resulting in decrease of growth, coxa vara and limb-length discrepancies. In past, the incidence of non-union varied from 7% to 10%, depending on the location of the fracture in the neck of femur the incidence of non-union in these fractures have significantly reduced in the recent times due to early anatomical reduction and rigid internal fixation. Due to the small number of cases, the treatment protocols for non-union of the paediatric femoral neck fractures are not well defined. Valgus osteotomy changes the shearing force at the non-union site to compression forces which provides optimal environment for bone union. Here we present a case of 6 years old child who presented with non-united fracture of the neck of femur with coxa vara, 1 year after conservatively treated osteomyelitis of proximal femur with valgus intertrochanteric osteotomy.

The effect of cinnopar on reducing the complications of femoral neck fracture in people aged 40 to 60 old

Background:Femoral neck fracture is a disabling injury that disrupts the patient's health. Because fracture healing is long and is sometimes unreliable, finding for fracture repair aids that accelerates healing speed and reliability helps in healing. Parathyroid hormone is a good option as a systematic mediator in calcium and bone metabolism.Objectives: The aim of this study was to use cinnopar to improve and accelerate rate of healing and reduce complications of femoral neck fractures in people aged 40 to 60 years.Methods: In this study, 34 femoral neck fracture patients were randomly divided into receiving cinnopar group(N=17) and not receiving cinnopar group(N=17). cinnopar was used in such a way that patients had 20 micrograms of cinnopar injected subcutaneously once a day and the other group received only routine postoperative drugs. Results : The average number of people who did not return to activity during the study period in the group receiving cinnopar 2 (33/13%)patients and in the group not receiving cinnopar 5 (33/33%) that the subjects in both groups compared with each other in terms of Return to activity during the three months after the operation the two groups were different (pvalue = 0.03) . Evaluation of the patients in terms of radiographic union three months after the operation showed that in the group receiving cinnopar , 10 union (66.66%), 3 incomplete union (20%) and 2 non union (13.33%) and in the group of not receiving cinnopar, 8 union (53.33%) 4 patients had incomplete union (26.66%) and 3 patients had non union (20%) and the two groups were similar.Conclusion:Receiving cinnopar immediately after femoral neck fracture surgery can reduce pain. It can also prevent non-return to activity during the first three months after surgery and improve femoral neck union .

Development and validation of a predictive nomogram for postoperative osteonecrosis of the femoral head with cannulated screws fixation.

BackgroundOsteonecrosis of the femoral head (ONFH) remains a major complication of femoral neck fractures. Early interventions require preliminary prediction and detection. In this study, we aimed to evaluate the perioperative variables of postoperative ONFH in femoral neck fracture patients with closed reduction and cannulated screw fixation. We also established and validated an individualized nomogram for the prediction of postoperative ONFH.MethodsWe included 470 patients with ONFH from two hospitals [First Affiliated Hospital of University of Science and Technology of China (n=360) and Southern Branch of the First Affiliated Hospital of the University of Science and Technology of China (n=110)]. We evaluated the prognostic value of multiple perioperative variables using a Cox regression model in the training cohort. We developed a nomogram for the prediction of ONFH using a logistic regression model. We assessed the performance of this nomogram in a validation cohort and evaluated its clinical value.ResultsOf the 470 patients who met the inclusion criteria, 141 (30.0%) developed postoperative ONFH. We found alcohol use [odds ratio (OR), 1.743, 95% confidence interval (CI), 1.042–2.901, P=0.033], cerebrovascular disease (OR, 5.357, 95% CI, 2.318–13.13, P<0.001), interval to surgery (OR, 5.273, 95% CI, 2.724–10.43, P<0.001), Garden classification (OR, 23.17, 95% CI, 6.812–145.3, P<0.001), Garden index (OR, 5.935, 95% CI, 2.670–14.184, P<0.001), interval to partial weight-bearing (OR, 0.053, 95% CI, 0.006–0.296, P=0.002), and six-month Harris hip score (OR, 0.856; 95% CI, 0.792–0.919, P<0.001) were independent predictors of postoperative development of ONFH. Based on these variables, we developed a nomogram that showed good discrimination in both the training [area under the curve (AUC) =0.865] and the validation cohort (AUC =0.877). The favorable performance of this nomogram was also confirmed in the validation cohort.ConclusionsWe developed and validated an easy-to-use nomogram for predicting postoperative ONFH. This nomogram can aid decision-making of intraoperative interventions and postoperative rehabilitation plans for patients, surgeons, and osteo-rehabilitative physicians.

Nonunion in Pediatric Femoral Neck Fractures.

➢ Nonunion is the third most common complication of femoral neck fractures in children after osteonecrosis and premature physeal closure causing coxa vara.➢ The most common cause of nonunion of a femoral neck fracture in developed countries is failure of fixation or loss of reduction, whereas in developing countries, it is delayed presentation.➢ Most failures of fixation, if identified in time (&lt;3 months), retain adequate bone contact. Hence, removal of the offending implant, refixation without bone-grafting, and valgus osteotomy to correct the biomechanical forces by converting the vertical fracture line into a horizontal fracture line provide adequate results with respect to osseous union.➢ In patients with a delayed presentation, the intervening fibrous tissue and resorption of the neck pose challenges. In these patients, in addition to performing a valgus osteotomy and fixation, in situ stabilization across the fibrous tissue and reconstruction of the inferomedial aspect of the neck using fibular strut-grafting, which adds stability, bone contact, and biological material, provide adequate union.

The Gamma Nail Versus DHS in the Treatments of Intertrochanteric Fractures

Intertrochanteric femoral Fractures forms approximately one percent of all fractures. To assess the functional outcomes, operative time, period of union, blood loss, and complications of femoral neck fracture treated with gamma nail versus DHS we managed 124 patients with closed intertrochanteric fractures, AO type A1 and A2, during the period between October 2012 and October 2017 followed up for 12–24 months at al Sader Teaching hospital in Najef/Iraq. There were 62 cases treated by gamma nails method and 62 patients treated by dynamic hip screws (DHS). Functionally outcome was measured using Harris Hip Score, fluoroscopic exposure, operative time, blood loss, period of union, reoperation rate, weight-bearing time, with other parameters. Regarding gamma nail method, the outcome was excellent in 42%, good in 45%, and fair in 9.7% and poor in 3.3% of cases, but with (DHS) method the outcome was excellent in 35.5%, good in 35.5%, fair in 19.3% and poor in 9.7%.We concluded that the gamma nail fixation method is superior to the (DHS) fixation method.

Evaluation of femoral head viability via bone scintigraphy in the postoperative pediatric patient.

Evaluating postoperative patients with hardware is challenging following surgical intervention for hip maladies such as femoral neck fractures and slipped capital femoral epiphysis (SCFE). These children are at increased risk of developing avascular necrosis, and imaging may be requested to confirm or exclude this diagnosis. Children with Legg-Calvé-Perthes disease can be monitored for restoration of blood flow to the capital femoral epiphysis to guide management and help with prognosis. Although MRI is sensitive for detecting early avascular necrosis, the presence of hardware degrades image quality. This report examines the utility of bone scans for evaluating femoral head perfusion in children who have undergone surgery for femoral neck fractures, SCFE or Legg-Calvé-Perthes disease. A retrospective review of 20 patients (22 scans) after fixation for femoral neck fracture, SCFE or Legg-Calvé-Perthes disease from 2012 to 2015 was performed. The bone scan findings were correlated with the intraoperative findings or clinical follow-up. Twenty-one of the 22 (95%) bone scans in 19 of the 20 (95%) patients demonstrated findings consistent with clinical outcomes and/or the intraoperative appearance of the femoral head. Four of 20 patients (20%) had bone scan features of avascular necrosis, defined as "absent" or "moderately diminished" femoral head activity, which were confirmed intraoperatively and resulted in poor outcomes. Radionuclide imaging of hips in the postoperative setting is a valuable modality for assessing the risk of avascular necrosis, a complication of femoral neck fractures and SCFE and for evaluating the restoration of flow to the capital femoral epiphyses of children with Legg-Calvé-Perthes disease.

Increased microRNA-93-5p inhibits osteogenic differentiation by targeting bone morphogenetic protein-2.

Background and purposeTrauma-induced osteonecrosis of the femoral head (TIONFH) is a major complication of femoral neck fractures. Degeneration and necrosis of subchondral bone can cause collapse, which results in hip joint dysfunction in patients. The destruction of bone metabolism homeostasis is an important factor for osteonecrosis. MicroRNAs (miRNAs) have an important role in regulating osteogenic differentiation, but the mechanisms underlying abnormal bone metabolism of TIONFH are poorly understood. In this study, we screened specific miRNAs in TIONFH by microarray and further explored the mechanism of osteogenic differentiation.DesignBlood samples from patients with TIONFH and patients without necrosis after trauma were compared by microarray, and bone collapse of necrotic bone tissue was evaluated by micro-CT and immunohistochemistry. To confirm the relationship between miRNA and osteogenic differentiation, we conducted cell culture experiments. We found that many miRNAs were significantly different, including miR-93-5p; the increase in this miRNA was verified by Q-PCR. Comparison of the tissue samples showed that miR-93-5p expression increased, and alkaline phosphatase (ALP) and osteopontin (OPN) levels decreased, suggesting miR-93-5p may be involved in osteogenic differentiation. Further bioinformatics analysis indicated that miR-93-5p can target bone morphogenetic protein 2 (BMP-2). A luciferase gene reporter assay was performed to confirm these findings. By simulating and/or inhibiting miR-93-5p expression in human bone marrow mesenchymal stem cells, we confirmed that osteogenic differentiation-related indictors, including BMP-2, Osterix, Runt-related transcription factor, ALP and OPN, were decreased by miR-93-5p.ConclusionOur study showed that increased miR-93-5p in TIONFH patients inhibited osteogenic differentiation, which may be associated with BMP-2 reduction. Therefore, miR-93-5p may be a potential target for prevention of TIONFH.

Osteonecrosis After Femoral Neck Fractures in Children and Adolescents

The most serious complication of femoral neck fractures in children and adolescents is osteonecrosis. Although a number of factors have been implicated in the development of osteonecrosis, no specific cause-and-effect relationship has been determined. The primary purpose of this study was to determine the prevalence of osteonecrosis in children and adolescents after femoral neck fractures and to identify risk factors for its development. This retrospective review identified 70 patients between the ages of 1.3 and 18.1 years who were treated for a femoral neck fracture between 2000 and 2011 at a single level I pediatric trauma center and followed until clinical and radiographic union. Demographic information, injury event details, type of surgical treatment, associated injuries, time from injury to treatment, and postoperative alignment were recorded from chart and radiographic review. The primary outcome was the presence of osteonecrosis, which was determined by review of available imaging. Multivariable logistic regression analysis tested age, time to treatment, type of fixation, mechanism of injury, postoperative alignment, and capsular decompression as possible risk factors for the development of osteonecrosis. Osteonecrosis occurred in 20 (29%) of the 70 patients. The median time to diagnosis of osteonecrosis was 7.8 months. Multivariable predictors of osteonecrosis included fracture displacement (P=0.01) and fracture location (P=0.02). Patient age, type of fixation, mechanism of injury, capsular decompression, postoperative alignment, and performance of reduction were not predictive of osteonecrosis after femoral neck fracture. Finally, time to treatment also was found to be a positive predictor of osteonecrosis (P=0.004), with osteonecrosis more likely in patients treated in less than 24 hours, but this finding is likely due to confounding because injury severity was closely linked to time to treatment. Regardless of the treatment, the prevalence of osteonecrosis after femoral neck fractures remains high. Recognizing factors that are predictive of the development of osteonecrosis can help surgeons counsel patients and families appropriately about the risk of this complication.

Spontaneous fracture of the femoral neck in preexisting avascular necrosis of femoral head in sickle cell disease

Avascular necrosis of the femoral head is a known complication of femoral neck fracture but on the contrary, femoral neck fracture in a case of preexisting avas-cular necrosis is a very rare phenomenon. We present a case study of a 47 year old Iraqi male who developed spontaneous ipsilateral subcapital femoral neck fracture under the condition of preexisting sickle cell disease and avascu-lar necrosis of the femoral head. The fracture was unnoticed for a few months. The patient was managed successfully by uncemented total hip arthroplasty. Postoperative recovery was uneventful and he was discharged 4 days after surgery. At 1 year’s follow-up, the patient had normal gait and hip function, with no sign of loosening or any other complications on radiograph.

Ipsilateral Femoral Fracture Non-Union and Delayed Union Treated By Hybrid Plate Nail Fixation and Vascularized Fibula Bone Grafting: A Case Report

Non-union is a well recognized complication of femoral neck fractures. The decision whether to attempt fracture fixation or to resort to hip replacement is particularly difficult in patients in the borderline age group in whom complex attempts at gaining union may fail and later present a difficult revision. On the other hand the patient may be young enough that arthroplasty best be avoided . Besides, presence of ipsilateral femoral shaft fracture with delayed union in addition to the femoral neck non-union will pose major problems at operation. We share our experience in treating a femoral neck fracture non-union with ipsilateral femoral shaft delayed union in the shaft and in the distal femur in a fifty years old patient. The fracture was treated with an angle blade plate and supracondylar nail supplemented with a free vascularised fibular bone grafting and autologous cancellous graft. There was radiological union at fourth month. At sixth months, the patient was free of pain and able to walk without support. Thus, we would like to suggest that vascularised fibula bone grafting with supracondylar nailing is a viable option for this pattern of fracture. Vascularized fibular bone graft, neck of femur, femoral shaft fracture, non-union.

A Tribute to Tan Sri Dr Abdul Majid bin Ismail

Non-union is a well recognized complication of femoral neck fractures. The decision whether to attempt fracture fixation or to resort to hip replacement is particularly difficult in patients in the borderline age group in whom complex attempts at gaining union may fail and later present a difficult revision. On the other hand the patient may be young enough that arthroplasty best be avoided . Besides, presence of ipsilateral femoral shaft fracture with delayed union in addition to the femoral neck non-union will pose major problems at operation. We share our experience in treating a femoral neck fracture non-union with ipsilateral femoral shaft delayed union in the shaft and in the distal femur in a fifty years old patient. The fracture was treated with an angle blade plate and supracondylar nail supplemented with a free vascularised fibular bone grafting and autologous cancellous graft. There was radiological union at fourth month. At sixth months, the patient was free of pain and able to walk without support. Thus, we would like to suggest that vascularised fibula bone grafting with supracondylar nailing is a viable option for this pattern of fracture.Vascularized fibular bone graft, neck of femur, femoral shaft fracture, non-union.

Time to internal fixation of femoral neck fractures in patients under sixty years—does this matter in the development of osteonecrosis of femoral head?

Osteonecrosis of femoral head remains a major complication of femoral neck fractures. It has been postulated that early internal fixation drastically reduces the incidence of osteonecrosis of the femoral head. However, there is a paucity of literature looking at the effect of time delay to internal fixation on the development of this late complication. In this study, we aim to assess the effect of time delay and method of internal fixation on the development of osteonecrosis in those less than 60 years of age. We retrospectively analysed 92 patients less than 60 years of age who presented with intracapsular neck of femur fractures that underwent internal fixation between 1999 and 2009. Of the 92 intracapsular fractures, 50 underwent fixation using cannulated screws, 32 using a dynamic hip screw, and ten using a dynamic hip screw with a derotation screw. In total, 13 patients (14.1 %) developed osteonecrosis of the femoral head, the highest incidence being in the cannulated screw fixation group with an osteonecrosis rate of 24 %. We did not find the time delay to internal fixation to be a significant predictor of the development of osteonecrosis. Our study demonstrated that the method of internal fixation rather than delay in internal fixation was more predictive of osteonecrosis of the femoral head. We did not find support to the current belief that early surgical fixation of neck of femur fractures reduces the risk of osteonecrosis in patients less than 60 years.

Fixation of femoral neck fractures with three screws: results and complications

To evaluate the results and complications of femoral neck fractures treated with internal fixation with three screws with an average follow-up of three years. Thirty seven patients operated upon between June 2000 and May 2005 for fractures of the femoral neck with three screws were identified as the study population. The final results of 26 patients (11 male, 15 female, with an average age of 39.8, range 16-69) that had a minimum of two year follow-up (average 37 months, range 24-64 months) were evaluated. Those patients that had additional fractures were not included in the evaluation. Preoperatively based on Garden classification four patients (15%) were Type I, eight patients (31%) were type 2, six patients (23%) were type three and eight patients (31%) were type 4. Functional results were evaluated according to the UCLA hip score. The average time to union was 5.5 months (range 3-12 months). One patient did not achieve union and a total hip replacement was done in the 15th postoperative month. Four patients had avascular necrosis (AVN) of the femoral head. The incidence of AVN in patients who had an operation within 24 hours of fracture was 9.5% while 40% in patients operated later than that. In patients with AVN one required a total hip replacement, another required treatment with bipolar hemiarthroplasty, the other two patients did not require further operations. One patient underwent bipolar hemiarthroplasty after screw pullout occurred on the 35th postoperative day. Fifteen patients (58%) had excellent results, five (19%) had good, 5 (19%) had moderate results and one (4%) had a poor result. Operative treatment with internal fixation using three screws in femoral neck fractures in the first 24 hours after a fracture gives favourable results in young patients that are too young to be considered for arthroplasty.

Examination of complications of femoral neck fracture in patients less than 65 years old

Examination of complications of femoral neck fracture in patients less than 65 years old

Posttraumatic Avascular Necrosis of the Femoral Head in Teenagers Treated by a Modified Transtrochanteric Rotational Osteotomy: A Report of Three Cases

Posttraumatic necrosis (AVN) of the femoral head in children is the most serious complication of femoral neck fractures in children, although it can also be seen after other injuries to the hip such as dislocations. There are only a few reports on the treatment for posttraumatic AVN, and options for treating this complication in the pediatric population are limited. We report our experience in managing 3 cases of posttraumatic avascular necrosis of the femoral head in teenagers with a modified transtrochanteric rotational osteotomy.

Risk Factors for Avascular Necrosis After Femoral Neck Fractures in Children: 25 Cincinnati Cases and Meta-analysis of 360 Cases

Avascular necrosis (AVN) is one of the most serious complications of femoral neck fractures in children. Variability in the reported rates of AVN and lack of statistical evidence has minimized the prognostic power of individual studies. The purpose of our study was to review our own cases as well as those from the literature in an effort to identify the risk factors for AVN. We conducted a computerized search of medical records to identify all children with femoral neck fractures treated at our institution from 1980 to 2003. Records were reviewed to determine fracture type (Delbet type I to IV), displacement, age, treatment, and incidence of AVN. A structured search of PubMed was also performed to identify all reports published in English, on femoral neck fractures in children, from 1965 to 2003. Hand searches of major orthopedic journals and reference lists of publications identified additional cases. Of the 275 citations initially identified through our computerized search, 47 met the criteria for further evaluation. These citations were reviewed by 2 investigators, and data was abstracted from 20 reports that provided patient-level data and met our criteria for inclusion. Twenty-four patients with 25 femoral neck fractures from our institution were identified including 12 boys and 12 girls with an average age of 8 years (range 1.5 to 16). Over 300 patients who met our study criteria were also identified from the literature, and a total of 360 patients were included in the analysis. Fracture type, displacement, age, and treatment were all statistically significant independent predictors of AVN with P values <or=0.05. With logistic regression analysis, however, fracture type and age were identified as the only significant predictors of AVN. Older children were 1.14 times more likely to develop AVN for each year of increasing age. Type I to III fractures were 15, 6, and 4 times, respectively, more likely to develop AVN than type IV fractures. AVN rate by Delbet class was I=38%, II=28%, III=18%, and IV=5%. Although several factors may contribute to the development of AVN, our meta-analysis provides statistical evidence that fracture type and age are the most significant predictors.

Evaluation of complications of femoral neck fractures in children operated on at least 24 hours after initial trauma

We evaluated complications and the factors affecting the development of avascular necrosis of the femoral head in children who underwent surgery for femoral neck fractures after at least a 24-hour delay. We reviewed the results of 22 children (11 boys, 11 girls; mean age 10 years; range 4 to 14 years) who were operated on after the first 24 hours for femoral neck fractures. According to the Delbet classification, two patients had type I, eleven patients had type II, and nine patients had type III fractures. Associated injuries were detected in seven patients. The mean duration from trauma to surgery was seven days (range 1 to 15 days). Internal fixation was performed following closed (n=20) or open (n=2) reduction. The results were assessed using the Ratliff criteria at the end of a mean follow-up of 73 months (range 18 to 184 months). The patients were evaluated with respect to age, type of fracture, displacement, complications, and avascular necrosis. The results were good in 12 (54.6%), fair in eight (36.4%), and poor in two patients (9.1%). Complications developed in 17 patients (77.3%), 12 of whom had more than one. The most frequent complication was premature physeal closure (n=14; 63.6%) followed by avascular necrosis (n=12; 54.6%). No significant differences were found (i) with regard to age and the type of fracture between patients with and without avascular necrosis, and (ii) with regard to avascular necrosis between patients who were treated within the first and second week of trauma (p>0.05). The results of surgery performed after the first 24 hours are mainly influenced by the occurrence of avascular necrosis and, secondarily, by the type of fracture.

TREATMENT OF PEDIATRIC FEMORAL NECK FRACTURE WITH DECOMPRESSION AND FIXATION

Background and Objective: Femoral neck fracture occurs rarely in children. Its lifetime prevalence in adult population of developed countries is 1%. There is no data from Iran. Avascular necrosis is the most important complication of femoral neck fracture. The most common methods of treatment are open and closed reduction and fixation. Recently, occurrence of avascular necrosis has been decreased by joint decompression and fixation. Material and methods: From1999 to 2002, ten children (7 girls, mean age, 7.2) were treated by joint decompression and fixation. The patients were followed for one year, using clinical examination, plain radiography and bone scan. Nine cases were operated upon within one week of fracture. Results: Avascular necrosis was observed in only 1 case. Discussion: Joint decompression and fixation should be done more frequently.