Displaced fractures of the hip in children

Abstract

Fractures of the hip in children have been associated with a very high rate of serious complications including avascular necrosis (up to 47%) and coxa vara (up to 32%). Over a period of 20 years, we have treated displaced fractures by early anatomical reduction, internal fixation and immobilisation in a spica cast to try to reduce these complications. We have reviewed 18 patients who had a displaced non-pathological fracture of the hip when under 16 years of age. Their mean age at the time of the injury was eight years (2 to 13). They returned for examination and radiography at a mean follow-up of eight years (2 to 17). Each patient had been treated by early (" 24 hours) closed or open reduction with internal fixation and 16 had immobilisation in a spica cast. By Delbet's classification, there was one type-I, eight type-II, eight type-III, and one type-IV fractures. There were no complications in 15 patients. Avascular necrosis occurred in one patient (type-III), nonunion in one (type-II, one of the two patients who did not have a cast) and premature physeal closure in one (type-I). There were no cases of infection or complications as a result of the cast. Our treatment of displaced hip fractures in children by early reduction, internal fixation, and immobilisation in a spica cast gave reduced rates of complications compared with that of large published series in the literature.

Delayed fixation of displaced type II and III pediatric femoral neck fractures

“…This is attributed to the better imaging facility, improved implants, and exclusion of Delbet type I fracture. However, our results are inferior to the recent reports in the literature121516 for two reasons: first, the fixation was done after a mean delay of 11.22 days and second, only displaced type II and type III fractures are included in the present series. AVN developed in three cases where reduction was subsequently lost.…”

Slipped capital femoral epiphysis after ipsilateral femoral neck fracture in an 11-year-old girl

“…3 The reported incidence of avascular necrosis after traumatic fracture-separation of the capital femoral epiphysis varies between 50 and 100%, whereas that following transcervical fracture varies between 18 and 52%. 1,6 The risk of avascular necrosis may be higher when a transcervical fracture of the neck of the femur is associated with an epiphyseal separation.…”

Long-term outcome of a child with a proximal femur fracture after high-energy trauma

“…There was a wide distance between the dislocated fracture fragments and a deep soft tissue damage of the intertrochanteric region ( Fig. 1a [4,8,12] ).…”

“…1,7 We report a favourable outcome in a child despite a high risk of developing complications due to severe displacement and severe soft tissue damage. 4,8,12 Case report…”