Delbet Classification Research Articles

A RARE CASE OF FEMORAL COLUMN FRACTURE IN CHILDREN WITH CLOSED REDUCTION AND SPICA CAST: A CASE REPORT

Background: Femoral column fracture is a rare case fracture in children. This is usually caused by high-energy trauma, such as falling from a height, or, in some cases, can also occur due to pathological fractures or repetitive trauma, such as running or jumping. Femoral column fractures can occure several complications, such as avascular necrosis (AVN), coxa vara, malunion, and osteonecrosis. Therefore, appropriate treatment is needed to reduce the risk of complications that may occur. Case Presentation: A 15 year old boy came to the emergency room with complaints of pain in base of his right thigh after falling while jumping over a tennis net with focus on his right leg. On examination, vital signs were normal, pain in the right groin had limited range of motion (ROM), and no other injuries or pain were found in his parts of the body. Then treatment was carried out using the closed reduction method and the installation of a spica cast without internal fixation. Conclusion: Although there is still a lot of controversy regarding the best time and method for administering therapy, determining the Delbet classification is very helpful as a consideration in choosing treatment and patient prognosis. In this case, treatment was given using close reduction and spica cast techniques with the consideration that anatomical reduction could be achieved.

Analysis of the Intra- and Inter-observer Reliabilities of Delbet Classification: Is Simplification Required.

This study aims to investigate the intra- and inter-reliabilities of Delbet classification and whether simplifying the classification improves reliability. The Radiographs of 58 patients under 16years old diagnosed with pediatric hip fractures between January 2012 and January 2020 were evaluated. Two separate Microsoft® PowerPoint (PPT) presentations consisting of 58 slides for Delbet's classification and its simplified form were prepared in which the order of cases was randomized and blinded. Then five orthopedic surgeons with different years of experience (more than 15years of surgical experience were accepted experienced group) in pediatric trauma surgery evaluated the presentations two times one month apart. In the inter-observer reliability analysis, a moderate agreement for the classical Delbet classification and a substantial agreement for the simplified Delbet classification was found in both evaluations. As a result of the intra-observer reliability analysis, there was substantial agreement in four observers, moderate agreement in one observer for the classical Delbet classification and substantial agreement in two observers, very good agreement in three observers for the simplified Delbet classification. The experience was not effective on agreement levels in the intra-observer reliability analysis of the classical Delbet classification system. The inter-reliability values of the less experienced group in the simplified classification were much higher than the classical Delbet classification. The simplification of the Delbet classification provides a significant increase in inter-observer reliability levels, especially in less experienced orthopedics and traumatology specialists, and a significant increase in intra-observer reliability levels. Level III, diagnostic study.

Three-Year Experience and Outcomes of Near-Early Internal Fixation for Femoral Neck Fractures in Pediatric Trauma Patients: A Retrospective Study.

Background The fractured neck of the femur in children is commonly caused by high-energy trauma, and despite its low incidence, complications are more frequent. Delayed presentation is not unusual in developing countries. The interval between injury and surgery is thought to be a critical factor in determining outcomes. This study aims to evaluate the effectiveness of "near early" internal fixation (24-72 hours)for fractured neck of the femur in children. Methods This is a retrospective observational study that analyzed complete case records from a period of seven years. Cases were classified according to the Delbet classification and outcomes were assessed using the Ratliff criteria with a minimum follow-up of three years. Results The study included 24 male and 11 female patients, with an average age of 11.28 years. The most common cause of injury was road traffic accidents. The fracture distribution in the study population was as follows: Delbet type II in 18 patients, Delbet type III in 10 patients, and Delbet type IV in seven patients. In our study, all patients underwent near-early fixation, meaning their fractures were fixed within 24-72 hours of injury.The average time for the clinical-radiological union was 8 weeks, and the most common complication was premature physeal fusion, followed by osteonecrosis. Conclusion In developing countries, where patients often experience delayed referrals and lack of awareness, near-early fixation (24-72 hours) of a fractured neck of the femur in children is a crucial option that holds significant value.

Robot-assisted cannulated compression screw internal fixation for treatment of femoral neck fracture in children: A case series of ten patients.

To investigate the safety and efficacy of robot-assisted cannulated compression screw internal fixation in the treatment of femoral neck fracture in children. We retrospectively reviewed the data of ten children with femoral neck fractures treated by robot-assisted internal fixation from January 2020 to June 2021. The clinical and radiological characteristics, operation duration, and fluoroscopy frequency of robot-assisted screws placement together with the complications and function were evaluated. At the 12-month follow-up, the hip joint function was evaluated using the Ratliff classification. Ten children, six boys and four girls, aged 4-14 years were included. There were eight type II and three type III femoral neck fractures using the Delbet classification. In the process of robot-assisted internal fixation, the median of fluoroscopy frequency was 22 times and the median of operation duration was 47 min. The median of screw parallelism was 1.33° and 0.66° on the anteroposterior and lateral x-ray films, and the median of screw distribution was 41.86% and 44.93% on the anteroposterior and lateral x-ray films, respectively. At the 12-month follow-up, there were two cases of femoral head necrosis, and fracture healing was achieved in all patients, of which eight fractures were excellent and three were good by the Ratliff function classification. The application of robot-assisted cannulated compression screw internal fixation could help us achieve more safe and accurate screw placement, as well as a good treatment effect for children's femoral neck fractures. Level IV. retrospective case series.

Fractura de cadera en la Infancia: serie de casos

ObjectivesShow the results obtained, describing the management and experience, knowing that the surgical delay time is much higher than that recommended in the current guidelines. Materials and methodRetrospective study of consecutive cases of hip fractures in the range of 0–16 years, with a minimum follow-up of 12 months. Where epidemiological variables were analyzed, delay in arrival at the Hospital, delay in surgical treatment, complications and functionality according to the Ratliff criteria. ResultsTwenty-one cases of hip fractures. An average age of 9 years, 71% left-sided involvement, one case of bilateral presentation. The trauma mechanism was 42.8% related to a traffic accident. There were associated injuries in 33.3%. Predominance of type IV and type III according to the Delbet classification. Surgical treatment in 95% of cases. The delay in arrival at the hospital was 1.6 days on average, with a delay in treatment of 5.45 days. Average follow-up of 29 months (12–54 months). Excellent functional results were obtained in 66.6% of cases, fair in 23.8%, and poor results in 9.5. Complications occurred in 7 cases, with NOA in 19% of patients, coxa vara in 8.5%, and length discrepancy in 4% (4%). ConclusionsThey are rare fractures. As pediatric orthopedists, we must be up-to-date in the management of each type of injury, in order to offer the appropriate treatment that reduces the sequelae that may potentially exist. The goal should be to obtain anatomical reductions and stable fixations. And surgical delay is not synonymous with poor results.

Postoperative avascular necrosis of the femoral head in pediatric femoral neck fractures.

This study aimed to evaluate the relevant factors of postoperative avascular necrosis of the femoral head (AVN) in children with femoral neck fracture. This study retrospectively analyzed the clinical data of 28 children with femoral neck fractures treated at our center between July 2016 and January 2019. The average age was 9.3 (range, 4.4-14) years with 75% male participants. Fracture classification was based on the Delbet classification: there were four, seven, 15, and two cases of type I, II, III, and IV fractures, respectively. Displacement degree was based on the Garden classification. Sixteen cases had insignificant displacement (Garden types I and II), six had medium displacement (Garden type III), and six had significant displacement (Garden type IV). There were six early (≤24 hours) and 22 delayed (>24 hours) surgeries. Twenty-three patients had satisfactory reduction, and five had unsatisfactory reduction. The mean postoperative follow-up period was 15.7 (range, 12-36) months. Follow-up was evaluated using the Ratliff scoring standards. The correlation between age, fracture classification, displacement degree, surgery timing, reduction quality, and other factors and AVN occurrence was statistically analyzed. Among 28 children, AVN was found in six cases. There were statistically significant differences in displacement degree (P = 0.001) and reduction quality (P = 0.001), while the occurrence of AVN did not significantly differ with sex (P = 0.117), age distribution (P = 0.218), fracture classification (P = 0.438), surgery timing (P = 0.255), and mechanism of injury (P = 0.436). The results of logistic regression analysis showed that displacement degree was a relevant risk factor (P = 0.049, odds ratio [OR] = 8.391, 95% confidence interval [CI]: 1.004-70.117), while reduction quality was not (P = 0.075, OR = 14.536, 95% CI: 0.757-278.928). Although the development of AVN in children with femoral neck fractures may be related to many factors, the results of this research suggest that there is a significant correlation between displacement degree and AVN occurrence.

Retrospective analysis of 35 pediatric femoral neck fractures.

Pediatric proximal femur fracture is extremely rare trauma comparing to other fractures. The proximal femur fracture is 1% of all pediatric fractures. The aim of current study is to compare the incidence of early complications and outcomes of pediatric proximal femur fractures regarding fracture types retrospectively. Our study includes 35 cases which are criticized by Delbet classification system, modalities of treatment, duration of waiting for surgery, duration of follow-up and also complications. Our inclusion criteria are age below 16years old, proximal femur fractures with no evidence of tumoral, romathologic and methabolic conditions. Age, sex and surgery type (open-closed) were noted, and the data were statistically assessed. Assessment of the final outcome was made at the last follow-up visit using the Ratliff's method. The mean of age of patients in our study is 9.5 ± 5.06years. The average follow-up was 25.6 ± 13.2months. 15 patients (42.9%) are type 2 Delbet fracture, 5 patients (14.2%) are Delbet type 3 and 15 patients (42.9%) are Delbet type 4 fracture. Using the Ratliff's method, 25 patients (71.4%) had satisfactory outcomes. Ten patients (28.6%) had unsatisfactory outcomes. The complications as AVN, coxa vara and premature closure of physis, non-union and postoperative infections have been detected in this study. AVN was seen in four (11.4%) patients. In addition, coxa vara was seen in six (17.2%) patients. Pediatric femoral neck fractures are extremely rare fractures and can be treated with low complication rates in cases with early treatment and anatomic reduction.

EVALUATION OF PEDIATRIC INTRACAPSULAR NECK OF FEMUR FRACTURE FIXATION WITH MOORE'S PINS

Paediatric femoral neck fractures are uncommon injuries and are usually caused by high-energy trauma. Low-energy trauma can result in pathological neck fractures and stress fractures of the neck, due to repetitive activity. Surgical options can vary based on age, Delbet classification and displacement of the fracture. Treatment for displaced fractures is by closed or open reduction and Moore’s fixation. Fixation should be supplemented by spica cast immobilization in younger children. The high rate of complications occurs due to the vascular anatomy of the hip and proximal femur. Avascular necrosis, coxa vara, premature physeal closure, and non-union are the most common and these often result in poor outcome.

Intertrochanteric Hip Fracture in a 4-year child: A Case Report

Hip fractures are rare in children and are less than 1% of all pediatric fractures and less than 1% of all cases of hip fracture. The literature agrees that early treatment, whether surgical or conservative, reduces the risk of complications. The clinical case we present concerns a pertrochanteric fracture with displacement of the greater trochanter in a 4-year-old child. The fracture was a type 4 according to Delbet classification. Clinical evaluation was carried out using the Ratliff scheme. Clinical criteria include pain, movement, activity and X-ray evaluation of the fracture both from the point of view of the formation of the bone callus, and the alteration of the diaphyseal cervical angle (DCA). It was surgically treated with three cannulated screws and a hip spica plaster cast immobilization with a Kirschner wire to avoid secondary displacement. The cast was maintained during the 6 weeks healing period of the fracture. After plaster cast removal, the child begins physiotherapy with an experienced physio in pediatric trauma. The child healed without complications.

Progress of hip fracture treatment in children

To review the progress of hip fracture treatment in children. Literature about the hip fracture treatment in children was extensively reviewed and summarized in terms of anatomy and blood supply, fracture classification, surgical treatment principles, and complications. The anatomical structure of children's hips and the characteristics of peripheral blood supply constantly change with age. Delbet classification is the most classic classification of hip fracture in children. Children's age and Delbet classification have significant effects on surgical treatment strategies and post-fracture complications. The timing of surgical treatment, accurate anatomical reduction, and appropriate internal fixation can effectively improve the prognosis and reduce the incidence of complications. Common complications include osteonecrosis of the femoral head, coxa vara, premature physeal closure, and nonunion. There are still some controversies on the treatment concept and internal fixation choice for children's hip fracture. So it is necessary to further study the anatomy and blood supply characteristics of children's hip, improve the selection and application skills of internal fixation devices, so as to avoid serious complications.

Femoral Neck Fractures in Children: A Review.

Paediatric femoral neck fractures are uncommon injuries and are usually caused by high-energy trauma. Low-energy trauma can result in pathologic neck fractures and stress fractures of the neck, due to repetitive activity. Surgical options can vary based on age, Delbet classification and displacement of the fracture. Treatment for displaced fractures is by closed or open reduction and smooth/cancellous screw fixation. Compression screw and side plate fixation is indicated for basal fractures. Fixation should be supplemented by spica cast immobilization in younger children. The high rate of complications occurs due to the vascular anatomy of the hip and proximal femur. Avascular necrosis, coxa vara, premature physeal closure, and nonunion are the most common and these often result in poor outcome.

Management of Pediatric Femoral Neck Fracture.

In the pediatric population, femoral neck fracture is a relatively uncommon injury with a high complication rate, despite appropriate diagnosis and management. The anatomy and blood supply of the proximal femur in the skeletally immature patient differs from that in the adult patient. Generally, these fractures result from high-energy trauma and are categorized using the Delbet classification system. This system both guides management and aids the clinician in determining the risk of osteonecrosis after these fractures. Other complications include physeal arrest, coxa vara, and nonunion. Multiple fracture fixation methods have been used, with the overall goal being anatomic reduction with stable fixation. Insufficiency fractures of the femoral neck, although rare, must also be considered in the differential diagnosis for the pediatric patient presenting with atraumatic hip pain.

Delayed treatment of femoral neck fractures in 58 children: open reduction internal fixation versus closed reduction internal fixation

The best treatment plan for femoral neck fractures in children in whom treatment is delayed by more than 24 h is unclear because of the limited number of such cases reported. This study compares the outcomes of closed and open reduction performed 24 h after the injury was sustained. We retrospectively reviewed 58 cases (40 males, 18 females) of femoral neck fractures reset after more than a 24-h delay at our hospital (May 2005 to May 2014). According to Delbet's classification, there were 30 type II fractures (51.7%), 21 type III fractures (36.2%), and seven type IV fractures (12.1%). A total of 21 patients underwent closed reduction and internal fixation; the remaining patients underwent open reduction and internal fixation. The follow-up period was 17-61 months (average, 35.1 months). The results were classified according to Ratliff's criteria. With the exception of one case of bone nonunion (closed reduction group), the fracture was healed in the remaining cases. The average healing time was 10.82 weeks (9-13 weeks). The incidence of avascular necrosis was significantly lower in the open reduction group. Further, the percentage of results classified as 'fine' according to Ratliff's criteria was significantly higher in the open reduction group than in the closed reduction group. Coxa vara occurred in three patients in the closed reduction group, but it did not occur in any of the patients in the open reduction group. The incidence of avascular necrosis was significantly lower in the patients who achieved anatomical reduction than in the patients who only achieved acceptable reduction. Finally, the results in the anatomical reduction group were obviously better than those in the acceptable reduction group. Open reduction with internal fixation yielded better outcomes than closed reduction in this group of children with displaced femoral neck fractures who were treated more than 24 h after the injury. This may be related to the better reduction quality in the open reduction group. Therapeutic studies: investigating the results of treatment, Level III.

Delayed treatment of 51 pediatric displaced femoral neck fractures

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

Femoral neck fractures in children and the role of early hip decompression in final outcome.

Femoral neck fractures in children are very rare and account for about 1% of all paediatric fractures. The aim of this retrospective study was to analyse the clinical and radiographic outcome in paediatric femoral neck fracture and to review the role of early decompression of the hip in the final outcome. The study was performed at the Department of Paediatric Orthopaedics and Traumatology, University Children's Hospital in Belgrade, Serbia from January 1996 to January 2010. The study included 28 patients, 12 female and 16 male, aged 4-14 years. Patients who were aged over 14 years or who had pathological femoral neck fractures or metabolic disturbances were excluded from the study. The type of neck fracture was determined according to the Delbet and Colonna classification. The patients were treated using different surgical procedures: closed reduction and cast immobilisation, closed reduction and percutaneous fixation with Kirschner wires (K-wires), closed reduction and fixation with cannulated screws and open reduction with Wagner plate stabilisation. The final outcome was evaluated using the clinical outcome (based on the Howorth-Ferguson scale), radiographic outcome and occurrence of complications. The median age of patients included in the study was 10.75 years and the average follow up was 9 years. According to the Delbet classification, there was one patient with type I, eight patients with type II, 16 patients with type III and three patients with type IV femoral neck fracture. Based on the Colonna classification, there were 23 displaced and five non-displaced femoral neck fractures. Decompression of the hip was performed in 21 patients. Avascular necrosis (AVN) developed as the main complication in 11 patients. The final outcome was excellent in 14 patients, good in four patients and poor in 14 patients. Our study unequivocally confirms the positive effect of urgent treatment on the incidence of AVN as well as on the outcome. We have established a 12-hour interval after injury as an optimal time limit for commencing treatment. Unambiguously positive effects of hip decompression on the incidence of AVN were also noted. We found similar efficiency for open and needle hip decompression.

Earlier time to reduction did not reduce rates of femoral head osteonecrosis in pediatric hip fractures.

Hip fractures account for less than 1% of all pediatric fractures; however, femoral head osteonecrosis (ON) after this injury ranges from 0% to 92%. The aim of this investigation was to add our experience to the literature and identify factors that may increase or decrease the risk of ON in pediatric patients with hip fractures. Institutional review board-approved retrospective review. Pediatric level II trauma center. Two hundred fifty-five pediatric hip fracture cases were reviewed from 1983 to 2009. Children were excluded if they had metabolic bone disease, subtrochanteric or pathologic fractures, slipped capital femoral epiphysis, or less than 1 year follow-up. This left 43 patients with 44 fractures in the study. Standard fixation procedures. Factors that could influence ON were analyzed and included age, Delbet classification, displacement, time to reduction, reduction quality and type, and whether a decompression was performed. Fisher exact tests were used with P <0.05 considered statistically significant. Of the 44 cases included in the study, 9 (20%) developed ON. Age ≥11 years was the only statistically significant independent predictor of ON (P = 0.04). The details of 3 unique cases are also presented. The rate of ON in this case series was 20%. No ON occurred in any child <11 years old. We were unable to demonstrate that earlier time to reduction reduced the incidence of ON. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Pediatric Femoral Neck Fractures: Our 10 Years of Experience

BackgroundFemoral neck fractures are rare injuries in children, but the high incidence of long term complications make it an important clinical entity. The aim of this retrospective study was to analyze the clinical outcomes of pediatric femur neck fractures that we managed over a 10 year period.MethodsThe study included 36 children (20 boys and 16 girls) who sustained femoral neck fractures and completed a minimum follow-up of one year. The children were treated either conservatively, or by open reduction and internal fixation (ORIF), or closed reduction and internal fixation (CRIF). The outcomes were analyzed using Ratliff criteria and a detailed record of complications was kept for all patients.ResultsThe mean age of included patients was 10 years (range, 3 to 16 years) and the average follow-up was 3.2 years (range, 1.1 to 8.5 years). Based on Delbet's classification system, there were 0 type I (transepiphyseal), 16 type II, 11 type III, and 9 type IV fractures. There were 8 undisplaced fractures, 4 of which later displaced after being managed initially in a hip spica. A satisfactory outcome was obtained in 27 (75%) children. Avascular necrosis (AVN) was the most common complication. It was seen in 7 of our patients, all of whom had an unsatisfactory outcome. Other complications included three cases each of coxa vara, non-union, and arthritic changes; and one case each of infection, primary screw perforation of head, and premature epiphyseal closure. Complications were lowest in the group treated by ORIF. Only 2 patients managed exclusively by conservative treatment ultimately achieved a satisfactory outcome.ConclusionsWe believe that internal fixation of pediatric femoral neck fractures is preferred whenever feasible because conservative treatment carries a high risk of failure of reduction. Aggressive operative treatments aimed at anatomical reduction should be the goal and there should be no hesitation in choosing ORIF over CRIF. Outcome of patients is influenced primarily by development of AVN which occurs as an independent entity without much relation to the mode of treatment carried out.

Displaced femoral neck fractures in children: Are complications predictable?

Serious complications can occur in the management of displaced femoral neck fractures in children. Are there ways to anticipate this risk and better define eventual contributing factors?Twenty-one children (14 boys and 7 girls) were treated between 1999 and 2006 for displaced femoral neck fractures. Nine type II, 10 type III and two type IV fractures were observed according to the Delbet's classification. Anatomical open reduction was performed in 13 patients and closed reduction in eight patients. At a mean follow-up of 26.4 months, the outcome was assessed according to the Ratliff criteria. Postoperative complications were analysed according to the age, fracture type, time-to-surgery and open or closed reduction.The mean age was 12.1 years. The final outcome was defined as good in 14 patients(66.66%), fair in one patient (4.76%) and poor in six patients (28.58%). Complications occurred in seven patients (33.33%), avascular necrosis (AVN) of the femoral head being the most frequent one (28.58%). In all cases, necrosis was observed in children older than 12 years (p < 0.05) and when time-to-surgery exceeded 48 h (p < 0.05). Necrosis occurred in 44.44% of type II fractures and in 20% of type III fractures (p > 0.05). Only one materialised after closed reduction (p < 0.05).Various factors may contribute to the development of complications in children with femoral neck fractures. Our study supports the hypothesis that older age, late surgery and open reduction are definite predictors of avascular necrosis occurrence.Retrospective study, level IV.

Pediatric femur neck fractures: A retrospective analysis of 39 hips

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.

Treatment of femoral neck fractures in pediatric patients.

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