Ipsilateral femoral neck and shaft fracture in children

Abstract

Rationale: Pediatric femoral shaft combined with ipsilateral femoral neck fractures are very rare but challenging injuries fraught with the development of avascular necrosis, coxa vara, and leg length discrepancy. Majority of the previous reports indicated the neck femur fracture was fixed with cannulated screws or/and pins, femoral shaft fracture was stabilized with a plate and screws. However, we used cannulated screws combined with elastic stable intramedullary nails to minimally invasive procedures treat this type of injury and achieved good follow-up results. Patient concerns: A 7-year-old boy (Case 1) was hospitalized due to a traffic accident resulting in swelling and deformity of the right thigh accompanied by limited mobility of hip and knee. A 5-year-old male child (Case 2) presented with pain and swelling in the bilateral lower limb after fall from approximately 12 feet. Diagnoses: Physical examination, X-ray film, and computed tomography were performed. Both patients were diagnosed with ipsilateral femoral neck and shaft fracture. Interventions: The fractures were reduced closed by image-intensifier imaging. Two partially threaded cancellous screws were used to fix femoral neck fracture, and elastic intramedullary nails were performed to stable the femoral shaft fracture. Postoperatively, the patients were immobilized in a one-and-a-half hip spica cast for six weeks. The internal fixations were removed after one year. Outcomes: Case one was follow-up at 14 months and the other one was followed up for 3 years. And at the last follow-up showed a normal and painless hip function. No clinical complications were found during follow-up visit, including head penetration, implant failure, fracture nonunion, avascular necrosis and hip varus deformity. Lessons: Clinician should carefully check and read relevant imaging data to avoid missed diagnosis. And the internal fixation method described in this paper may be more minimally invasive.

Do All Pediatric Femoral Shaft Fractures Need a Computed Tomography Scan of the Ipsilateral Femoral Neck? Calculating the Incidence of Concomitant Femoral Neck and Shaft Fractures

“…Age can have a significant effect on the mechanism of injury and fracture pattern in the setting of pediatric and adolescent femur fractures. As opposed to adults, younger pediatric femoral shaft fractures are often associated with low-energy trauma, whereas high-energy trauma is more common in adolescent-aged patients 8,30. In contrast to low-energy femoral shaft fractures, high-energy femoral shaft fractures are more likely to have associated femoral neck fractures ipsilaterally.…”

“…As opposed to adults, younger pediatric femoral shaft fractures are often associated with low-energy trauma, whereas high-energy trauma is more common in adolescent-aged patients. 8,30 In contrast to low-energy femoral shaft fractures, highenergy femoral shaft fractures are more likely to have associated femoral neck fractures ipsilaterally. This is further substantiated by our data, where the mean age of isolated shaft fractures was just under 6 compared with the mean age of femoral neck fractures at about 11 years of age.…”

“…5,6 However, there is a shortage of literature discussing the incidence of concomitant ipsilateral femoral neck and shaft fractures in the pediatric population. The majority of studies regarding this topic are case studies or small case series [7][8][9][10][11] and therefore the true incidence of this clinical scenario in pediatric orthopaedics is unknown. 12 In adults, missed femoral neck and shaft injuries are associated with significant morbidity.…”