Femoral neck fracture in children: treatment and complications

Akkari, Miguel; Santili, Cláudio; Akel, E; Angelim, Rebeca Coelho de Moura

doi:10.1590/1806-9282.61.01.005

Cited by 14 publications

(9 citation statements)

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“…Femoral neck fracture is a rare injury in pediatric patients, accounting for approximately 1% of all fractures in childhood [1,2] but yields relatively frequent surgical complications, such as avascular necrosis (AVN) of the femoral head, nonunion of fracture, coxa vara, and premature physeal closure (PPC) [3][4][5]. These complications may be attributed to the open physis in the proximal femur and fragile structure of blood support for the femoral head in pediatric patients [6,7] and could lead to antalgic gait, permanent limping, and limited range of motion [3,4,8].…”

Section: Introductionmentioning

confidence: 99%

Analysis of risk factors for complications after femoral neck fracture in pediatric patients

et al. 2020

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Background: Pediatric femoral neck fracture is a rare injury but yields frequent complications. However, there is a paucity of data regarding the risk factors for these complications. Purpose: The present article reports the rate of complications after femoral neck fracture in pediatric patients and investigates the possible risk factors. Methods: We retrospectively reviewed 44 children (mean age of 9.0 years, range from 2 to 14 years) who were surgically treated for femoral neck fracture in a single trauma center with a mean follow-up of 57.75 months (range from 11 to 224 months). Related clinical factors were recorded and analyzed by multivariable logistic regression. Results: Fracture displacement or Delbet-type fracture had no relation to the injury mechanism. However, younger children experienced severe trauma, combined injury, and low fracture location more than older individuals did. Children with combined injuries were more likely to have a longer waiting time for surgical reduction. Common complications included avascular necrosis (AVN) in 14 cases, nonunion of fracture in 2 cases, coxa vara in 4 cases, and premature physeal closure (PPC) in 7 cases. Only the Delbet type was an independent predictor of AVN (OR = 0.14, p = 0.030). Inadequate reduction was associated with higher rates of coxa vara (OR = 33.19, p = 0.032). Epiphysis penetration in children younger than 10 years old increased the rate of PPC (p = 0.032). No significant risk factor was found for fracture nonunion. Conclusion: For femoral neck fracture in pediatric patients, both the injury mechanism and fracture characteristics have age-related distributions. Early reduction should be carried out as early as possible based on the safe condition of the child, but for younger children, transepiphyseal fixation should be avoided. AVN may be intrinsic to injury characteristics rather than resulting from the choice of treatment mode.

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Section: Introductionmentioning

confidence: 99%

Analysis of risk factors for complications after femoral neck fracture in pediatric patients

et al. 2020

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“…Femoral neck fractures are rare injuries and account for less than 1% of all pediatric fractures. [1234567] These fractures result mainly from high energy trauma as in motor vehicle accident or fall from height. [6] Their treatment by closed or open reduction and internal fixation as soon as possible within 24 h is recommended by most authors to decrease the risk of avascular necrosis (AVN).…”

Section: Introductionmentioning

confidence: 99%

Management of femoral neck fractures in children: Experience of a short series in a developing country

Yaokreh

Odéhouri-Koudou

Dieth

et al. 2018

Afr J Paediatr Surg

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Background: Fractures of the femoral neck are rare injuries in children but can have many devastating complications. Their treatment is not standardized, but the objectives are early anatomic reduction to minimize the risk for complications. The aim of this study was to assess outcomes of a short series of femoral neck fractures managed in a resource-limited setting. Materials and Methods: The medical charts of 11 children who were managed in our institution for femoral neck fractures between January 2000 and December 2015 were assessed retrospectively. There were two cases ( n = 2) of Delbet type I, 5 ( n = 5) type II, and 4 ( n = 4) type III fractures. Patients were treated either surgically by open reduction and internal fixation ( n = 4) or conservatively by traction followed by spica cast ( n = 7). Outcomes were assessed using Ratliff system. Results: Femoral neck fracture incidence was one case per year. Of the 11 patients, there were 7 boys and 4 girls, with a mean age 9.4 ± 3.28 years. At the mean follow-up of 3.64 ± 1.97 years (range, 2–8.8 years), outcome was fair to good in 8 (72.7%) and poor in 3 (27.3%) cases. Average union time was 13.5 ± 1.77 weeks. Complication rate was 72.7%. Avascular necrosis occurred in three cases (27.3%). Six patients (54.5%) developed coxa vara, with a mean neck-shaft angle of 102.16° ±12.07° (range, 90°–118°). Five patients (45.5%) had leg length discrepancy with a mean 18 mm (range, 7–35 mm). Discussion: Local conditions negatively influenced the management of femoral neck fractures. Conservative treatment led to many complications which increase the cost of management.

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“…Subsequently, infection, skin problems, and chondrolysis may develop associated with the treatment [14]. As these complications lead to functional disability, the patient must be closely monitored from the time of the fracture until complete bone union.…”

Section: Introductionmentioning

confidence: 99%

“…The quality of results varies depending on the initial amount of fracture displacement, the fracture type, the age of the patient, the time of fixation, the type and quality of reduction, and the type and number of fixation materials [7]. Avascular necrosis is the most frequently encountered and most serious complication following fractures of the proximal femur [14]. Primarily, the medial circumflex artery and the arteria femoris capitis provide the blood supply to the femoral neck region.…”

Section: Introductionmentioning

confidence: 99%

“…This tenuous blood supply to the femoral head is a direct cause of poor functional results after femoral neck fracture. The development of avascular necrosis is directly related to the initial fracture displacement or the displacement following reduction [14][15][16]. In pediatric hip fractures, the damage to the vessels providing the blood supply to the femoral head is proportional to the degree of fracture displacement and it is the most significant risk factor triggering the development of avascular necrosis.…”

Section: Introductionmentioning

confidence: 99%

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Early prediction of outcomes in hip fractures

Baysal

Ecevız

Bulut

et al. 2016

Journal of Pediatric Orthopaedics B

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We retrospectively analyzed the surgical treatment of 28 pediatric hip fractures. The majority of cases were Delbet type 2 (57%) and type 3 (29%). The average age of the patients was 10.8 years (range: 2-16 years). The mean follow-up period was 91 months. Displaced fractures were found in 18 cases (64%). The major factor in the development of avascular necrosis was the degree of displacement at the time of initial presentation (P<0.05), irrespective of fracture type. Although the degree of initial displacement cannot be prevented, careful exposure of soft tissue during open reduction will reduce avascular necrosis.

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Femoral neck fracture in children: treatment and complications

Abstract: GUIDELINES IN FOCUSFemoral neck fracture in children: treatment and complications fratura do cólo do fêMur eM crianças: trataMento e coMplicações

Cited by 14 publications

References 14 publications

Analysis of risk factors for complications after femoral neck fracture in pediatric patients

Analysis of risk factors for complications after femoral neck fracture in pediatric patients

Management of femoral neck fractures in children: Experience of a short series in a developing country

Early prediction of outcomes in hip fractures

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