Vascular evaluation after cervical hip fractures in children

Abstract

Femoral neck fractures in children and young adults are rare, but have a high risk of avascular necrosis (AVN) and subsequent gradual collapse of the femoral head. In 2006, we initiated the use of scintigraphy for the diagnosis of vascular impairment after a cervical fracture in children. In the present retrospective case study, we evaluated the effect of the remaining postoperative circulation in the femoral head after fracture in terms of the development of AVN and secondary degenerative changes of the hip joint. Eight children, four girls and four boys [mean age 11.5 years (7-16)], had been operated for a cervical or a basocervical hip fracture between 2006 and 2012. The femoral head circulation was evaluated postoperatively with scintigraphy and all children had been followed radiographically for a minimum of 1 year. The Ficat classification was used to stage the AVN and the Stulberg classification was used to stage the sphericity of the femoral head at follow-up. In two patients, the femoral head had normal circulation postoperatively and they also had normal radiographs at follow-up. In two patients, the entire femoral head was avascular postoperatively and at follow-up, one patient had normal radiographs and one had both subchondral sclerosis and flattening. These two patients had been treated with bisphosphonates and prolonged non-weight-bearing. Four patients had postoperatively retained circulation in parts of the femoral head. Three of these four patients had normal radiographs at follow-up. Evaluation of the remaining circulation after surgery may help to predict the outcome and guide the postoperative regime in children with a femoral neck fracture.

Rare case of posterior hip dislocation caused by low-energy trauma in a boy in early adolescence: acute and long-term management–review of the literature

“…Risk of AVN increases with age, time interval between injury and reduction, and severity of trauma; however, no correlation has been found with prolonged immobilisation postoperatively (eg, duration of non-weight-bearing, partial or none) 7 8. Although there is no correlation between weight-bearing and AVN, non-weight-bearing can be effective in preventing collapse of the subchondral bone 9. Leg length discrepancy and angular deformities of the femoral neck also raise concerns when dealing with children, especially those under 12 years of age 7.…”