PURPOSE: Paediatric femur neck fractures are exceedingly rare owing to dense bone surrounded by a strong periosteum; they account for 1 % of paediatric fractures and are usually associated with high energy trauma. METHODS: This was a prospective multicenter therapeutic study on pediatric femoral neck fractures from June 2004 to September 2013 at three centres in Odisha, India. Children with femoral neck fractures (Delbet type 2 and 3) who were operated and completed a minimum one-year follow-up were included. We divided the neck of femur (100 %) into four zones (25 % each), with zone I being highly unstable and zone IV being most stable. Implants for fixation, as suggested by pre-operative zone distribution, were used. RESULTS: Twenty-eight children were studied with mean two- to seven-year follow-up. In 23 children cancellous screws were used. In zone I Smooth Moore's pins that crossed the epiphysis were the implant of choice. Causes were avascular necrosis (14.2 %), nonunion (7.14 %) and one case of implant failure, while coxa vara was encountered in two instances. Functional results (Ratliff's criteria) were good in 82.1 %, fair in 7.1 % and poor in 10.7 % of patients; the mean IOWA hip scores were 96, 94 and 98, respectively. CONCLUSION: Early surgical intervention hastens recovery, rehabilitation and return to school and decreases the risk of developing avascular necrosis. We suggest Smooth Pins fixation in zones I and II (nearer to zone I) and cancellous screw fixation in zones II, III and IV. Decompression of hip joint by capsulotomy releases the tamponade effect and should be performed in all cases of paediatric femoral neck fractures.
PURPOSE: Paediatric femur neck fractures are exceedingly rare owing to dense bone surrounded by a strong periosteum; they account for 1 % of paediatric fractures and are usually associated with high energy trauma. METHODS: This was a prospective multicenter therapeutic study on pediatric femoral neck fractures from June 2004 to September 2013 at three centres in Odisha, India. Children with femoral neck fractures (Delbet type 2 and 3) who were operated and completed a minimum one-year follow-up were included. We divided the neck of femur (100 %) into four zones (25 % each), with zone I being highly unstable and zone IV being most stable. Implants for fixation, as suggested by pre-operative zone distribution, were used. RESULTS: Twenty-eight children were studied with mean two- to seven-year follow-up. In 23 children cancellous screws were used. In zone I Smooth Moore's pins that crossed the epiphysis were the implant of choice. Causes were avascular necrosis (14.2 %), nonunion (7.14 %) and one case of implant failure, while coxa vara was encountered in two instances. Functional results (Ratliff's criteria) were good in 82.1 %, fair in 7.1 % and poor in 10.7 % of patients; the mean IOWA hip scores were 96, 94 and 98, respectively. CONCLUSION: Early surgical intervention hastens recovery, rehabilitation and return to school and decreases the risk of developing avascular necrosis. We suggest Smooth Pins fixation in zones I and II (nearer to zone I) and cancellous screw fixation in zones II, III and IV. Decompression of hip joint by capsulotomy releases the tamponade effect and should be performed in all cases of paediatric femoral neck fractures.
Authors: Claudia Druschel; Katherina Heck; Peter Heinrich Pennekamp; Matthias Wimmer; Julia Franziska Funk; Richard Placzek Journal: Int Orthop Date: 2015-07-31 Impact factor: 3.075