Delayed fixation of the transcervical fracture of the neck of the femur in the pediatric population: Results and complications

Abstract

Purpose To determine the impact of a substantial delay in providing surgical treatment on the final outcome in transcervical femoral neck fractures in children. Methods Data on all pediatric patients with transcervical fractures of the femoral neck that were fixed by reduction and internal fixation after a delay of C7 days in our department between 2000 and 2008 were collected both retrospectively and prospectively. Results The medical records of 14 patients (15 fractures) were analyzed. The results after an average of 43 months of follow-up showed that the complication and avascular necrosis rates were higher in cases in which treatment had been delayed compared to those in comparable fractures that had been treated promptly after the event in other series. Nine of the 15 fractures had developed avascular necrosis at final follow-up. Overall, there were four excellent, three good, and eight poor results (based on the Ratliff criteria). Conclusions Children whose transcervical fractures of the femoral neck were surgically treated after a delay of 1 week or longer had a high avascular necrosis rate and a relatively poor outcome. Reduction and internal fixation as the initial treatment should be implemented shortly after injury in order to enhance treatment outcome.

Early prediction of outcomes in hip fractures

“…In patients undergoing surgery after the first 24 h, similar rates of avascular necrosis have been reported [17,18]. In the current study, 24 (85%) of the 28 patients were operated on within the first 24 h. The other four patients underwent surgery on the third, sixth, seventh, and eighth days, respectively.…”

Proximal femoral fractures in children and adolescents

“…9,13,15,16--20 Two recent studies retrospectively evaluated the outcomes of hip fractures treated more than 1 week after injury. 18,19 As expected, there were poor outcomes and a higher rate of avascular necrosis in those treated more than 1 week after injury. Some authors argue that the initial severity of trauma may be more important than the timing with respect to development of osteonecrosis.…”

Intertrochanteric hip fracture in a 6-year-old girl treated with pediatric sliding hip screw: case report

“…В отличие от низкоэнергетических травм, характерных для пожилых людей, у детей обычно встречаются высокоэнергетические ПБ, которые в 30 % случаев сопровождаются повреждениями другой конечности, повреждениями внутренних органов и травмами головы [1]. Иногда перелом бедра у детей является результатом незначитель-ной травмы кости, ослабленной опухолью (напри-мер, однокамерная киста кости, фиброзная дис-плазия), или нарушением метаболизма костной ткани [1,2].…”

“…Среди потенциальных осложнений таких переломов выделяют хондро-лиз, асептический некроз, варусную деформацию, отсутствие консолидации, отсроченный физиолиз, преждевременное закрытие зоны роста, а также другие нарушения роста, способные привести к различной длине конечностей или к угловым деформациям [1]. К факторам, которые потенциально могут по-влиять на развитие осложнений, относятся исход-ная степень смещения, длительность промежут-ка времени между повреждением и репозицией, качество и стабильность репозиции и фиксации, декомпрессия тазобедренного сустава и статус ве-совой нагрузки [2].…”