Fractures of the neck of femur in children: an experience at the Aseer Central Hospital, Abha, Saudi Arabia.

The Orthopaedics Unit of Aseer Central Hospital, Abha, Saudi Arabia became fully operational in 1992. From then till 1999, 14 cases of fractures of the neck of femur in children under the age of 16 years were studied. The aims of the study were to compare our experience with those of other institutions and to serve as a reference point in this region for future study of this rare but disabling condition. The case notes of all the patients aged less than 16 years with fractures of the neck of femur managed at the Aseer Central Hospital between 1992 and 1999 were analysed retrospectively. Information obtained included age, sex, type of fracture, management, outcomes and complications. There were 14 children. The age range between 4 and 16 years (mean = 9.1 +/- 3.8 years). Male to female ratio was 1:1.3. Eight cases (57.1%) were due to road traffic crashes and 6 (42.9%) were due to falls from height. Six cases (42.9%) were of Delbet type II (transcervical) fractures, 5 cases (35.7%) were of type III (cervicotrochanteric), and 3 cases (21.4%) were of type IV (intertrochanteric) fractures. There was no case of Delbet type I (transepiphyseal separation). Patients were treated either surgically by reduction and internal fixation or conservatively by traction followed by hip spica cast application. Avascular necrosis occurred in 7 cases (50.0%). Only 3 cases of partial avascular necrosis were seen and all the 3 improved. The rest 4 (28.6%) had collapse of the femoral head. In only 2 cases (14.3%) of femoral neck fracture, the patients did not have any associated injuries. While fracture of neck of the femur is rare in children, the high incidence of complications that can lead to life-long disability makes it an important clinical entity.