Management of femoral neck fractures in children: Experience of a short series in a developing country

Abstract

Background: Fractures of the femoral neck are rare injuries in children but can have many devastating complications. Their treatment is not standardized, but the objectives are early anatomic reduction to minimize the risk for complications. The aim of this study was to assess outcomes of a short series of femoral neck fractures managed in a resource-limited setting. Materials and Methods: The medical charts of 11 children who were managed in our institution for femoral neck fractures between January 2000 and December 2015 were assessed retrospectively. There were two cases ( n = 2) of Delbet type I, 5 ( n = 5) type II, and 4 ( n = 4) type III fractures. Patients were treated either surgically by open reduction and internal fixation ( n = 4) or conservatively by traction followed by spica cast ( n = 7). Outcomes were assessed using Ratliff system. Results: Femoral neck fracture incidence was one case per year. Of the 11 patients, there were 7 boys and 4 girls, with a mean age 9.4 ± 3.28 years. At the mean follow-up of 3.64 ± 1.97 years (range, 2–8.8 years), outcome was fair to good in 8 (72.7%) and poor in 3 (27.3%) cases. Average union time was 13.5 ± 1.77 weeks. Complication rate was 72.7%. Avascular necrosis occurred in three cases (27.3%). Six patients (54.5%) developed coxa vara, with a mean neck-shaft angle of 102.16° ±12.07° (range, 90°–118°). Five patients (45.5%) had leg length discrepancy with a mean 18 mm (range, 7–35 mm). Discussion: Local conditions negatively influenced the management of femoral neck fractures. Conservative treatment led to many complications which increase the cost of management.

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

“…In the current series, there was no case of nonunion and all fractures healed at 3.31 ± 1.04 months. This finding was consistent with the report available in literature ( 15 ).…”

“…In the current series, there was no case of nonunion and all fractures healed at 3.31 ± 1.04 months. This finding was consistent with the report available in literature (15). We did not register any case of neck collapse among the patients enrolled in our dataset; however, we reported a case of spontaneous dislocation in a noncompliant patient, a 15-year-old male (who sustained a Delbet type II femoral neck fracture and operated with our protocol approach) 10 months postoperatively (Figures 2A,B).…”

“…In a study conducted in pediatric patients aged between 3 and 16 years, treated with internal fixation using cannulated screw, Morsy ( 8 ) reported an incidence of Coxa vara of 36%. Yaokreh et al ( 15 ) reported a rate of 54.5% patients who developed coxa vara, with a mean neck–shaft angle of 102.16° ± 12.07°, ranging from 90°–118°, all present in the group of patients treated with conservative management. The anatomical reduction and internal fixation can be used to efficiently control the incidence rate of coxa vara ( 7 , 14 ).…”

“…Historically, different management options for femoral neck fractures in pediatric patients have been of routine use including conservative management with prolonged balanced traction, prolonged casting, percutaneous fixation, closed reductioninternal fixation, and open reduction and fixation with K-wires (11)(12)(13)(14). The primary treatment goal is to achieve accurate anatomical reduction and stable internal fixation, thus, avoiding fracture complications, but the best treatment approach remained controversial (15). Recently, some scholars recommended the use of 6.5 or 7.3 mm cannulated cancellous screws (CCSs) in Delbet type I-III adolescent hip fractures (in patients aged above 10 years) (16).…”

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

“…Table 5 presents a comparison of our study with other similar studies [21,[28][29][30]. Bali et al (36 patients) recommended that internal fixation as a conservative treatment was associated with a higher risk of loss of reduction [28].…”