Fractures of the femoral neck in children: complications and their treatment

Chladek P, Trc T. Acta Chir Orthop Traumatol Cech 2002;69(1):31-4

PURPOSE OF THE STUDY: Fractures of femoral neck in children are rare skeletal injuries which are, however, associated with a high percentage of complications. The aim of the retrospective study is to evaluate a group of patients in relation to the incidence of individual complications and demonstrate the methods used for the solution of these complications. MATERIAL: Twenty patients with fractures of femoral neck (average age 10 years 5 months) were treated at the Department of the authors in the period between 1983 and 1997. Of this 18 patients were operated on (most frequently used was internal fixation by 2 cancellous screws). In the given period 10 complications in total were handled of which 3 patients were admitted to the Department due to a complication which occurred after the surgical treatment of the fracture at another department. The group included neither pathological fractures nor patients with hormone-based slipped capital femoral epiphysis. METHODS: Fresh fractures of femoral neck were classified after Boitzy or Delbet-Collona. The results of the treatment of both fresh fractures and complications were evaluated after the interval of more than three years. RESULTS: Of 20 cases treated primarily at our Department 13 patients healed completely. Complications occurred in 10 cases (43.5% of all treated cases). The most frequent complication was avascular necrosis of femoral head (17.4% of all treated cases). This complication was managed twice by proximal femoral osteotomy, and once by arthrodesis of the hip joint and once by a triple pelvis osteotomy. The evaluation of complications shows that the more medial the neck fractured the greater was the risk of the incidence of some complication. DISCUSSION: The percentage of individual types of fractures is comparable with the results presented in the cited works, only Cheng presents an unusually share of fractures of type II to the debridement of type III. The incidence of avascular necrosis is relatively lower in the given group as compared to the cited works (Mayr states 34.6% in patients operated on). Similarly skeptical is the evaluation of fractures of type I also in other authors (Pape). CONCLUSIONS: The authors recommend as a method of choice in these fractures an early surgical treatment with emphasis on exact anatomical reduction of fragments combined with intraarticular decompression by arthrotomy in case of the presence of hemarthrosis.