Complication rate after operative treatment of paediatric femoral neck fractures

Abstract

Paediatric fractured neck of femur injuries is rare and historically has high complication rates postoperatively. We present results from the Birmingham Children's Hospital. Fifteen displaced femoral neck fractures were identified in 14 children over a 10-year period (1997-2006). Mean age at the time of injury was 10 years (range 6-14 years). Mean follow-up was 31 months (range 6-110 months). Anatomical reduction and internal fixation was performed in all cases. Two fractures were classified as Delbet's type-I (13.3%), four type-II (26.7%), six type-III (40%) and three type-IV fractures (20%). Eleven patients were operated on within 24 h (range 4-19 h) and four after 24 h (range 2-11 days). The rate of avascular necrosis was 6.7% overall and 10% excluding pathological fractures. The rate of premature physeal closure was 33.3% overall and 40% excluding pathological fractures. Ninety-three percent of the total study population had a good result according to the Ratliff scoring system. There were no nonunions. One patient had a poor result with avascular necrosis and collapse.

Femoral neck fractures in osteogenesis imperfecta patients: A retrospective case series and novel surgical technique

“…[10,11] AVN is another feared complication in pathologic femoral neck fractures in young patients and in our series no patients developed this. [4,11] Figure 7. Case 3 -Routine post op imaging demonstrates screw cut out anterior and superior with loss of fixation OI patients with femoral neck fractures often have poor bone quality and small areas for implant purchase with pre-existing hardware and dysmorphic proximal femurs, making it difficult to achieve adequate fixation.…”

“…[3] These are frequently the result of either high energy trauma in healthy bone or minimal trauma in pathologic bone. [4] The Delbet system is used to classify these fractures in children. Frequent complications of these fractures include avascular necrosis, coxa vara, premature physeal closure, and leg length discrepancy.…”

Management pitfalls of fractured neck of femur in osteogenesis imperfecta

“…We found only one related article. We have summarised all the six English literatures [11][12][13][14][15][16] available regarding fractures of the neck of femur in patients with OI (Table 2). Furthermore, only a few studies had detailed documentation of the treatment methods and outcome.…”

Bilateral femoral neck fracture in a child

“…Most of these complications are attributed to a severely compromised vascular supply of femoral head that results from initial displacement, intracapsular hematoma, the proximal location of the fracture or the applied treatment method. However, other causative factors such as inappropriate patient selection for nonoperative treatment [6,15], the surgeon's lack of experience, pin penetration through physis [6,16], or inadequate reduction are also suspected [6,17]. The type of fracture, initial displacement, and the patient's age are considered by some researchers as the main factors that determine the outcome [3,6,16,[18][19][20][21][22].…”