Complications of fracture of the neck of the femur in children. A long-term follow-up study.

This is a long-term study of 53 children with fracture of the proximal femur. The age of these children at the time of injury ranged from 3 to 16 years (average, 10.2 years). The follow-up period averaged 9.4 years (range, 5-20 years). There was a single transepiphyseal fracture, 28 transcervical fractures, 21 basicervical fractures and three intertrochanteric fractures. The overall results were good in 49, fair in 25 and poor in 26% of patients. Better results were obtained in undisplaced fractures and in those displaced fractures where anatomical reduction was achieved and maintained throughout fracture healing. The rate of early and delayed complications was 60%, with some patients having more than one complication. Avascular necrosis occurred in 40%. It was found to be related to initial fracture displacement and was associated was an inferior outcome. Other complications included coxa vara in 36, non-union in 36, premature physeal closure in 38, shortening in 55, arthritic changes in 34, coxa valga in 9, coxa magna in 2, and post-operative infection in 23% of patients. The quality of reduction appeared to influence the occurrence of some complications such as avascular necrosis and non-union.