Femoral neck fractures in children and the role of early hip decompression in final outcome

Bukva, Bojan; Abramovic, Dusan; Vrgoč, Goran; Marinović, Marin; Bakota, Bore; Dučić, Siniša; Miškulin, Mladen; Brdar, Radivoj; Čoklo, Miran; Gulan, Gordan

doi:10.1016/j.injury.2015.10.059

Cited by 38 publications

(39 citation statements)

References 15 publications

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“…A number of authors have speculated on the utility of capsular decompression, either by anterior hip capsulotomy or needle decompression, however, only a few studies have provided objective evidence towards or against the utility of decompression. [14][15][16] These studies found statistically significant fewer complications when capsulotomy was performed. One study found increased rates of AVN with capsulotomy, but the study results were likely confounded by all treatments being delayed greater than 24 h following initial injury.…”

Section: Capsular Decompressionmentioning

confidence: 88%

Pediatric proximal femur fractures

Dial

Lark

2018

Journal of Orthopaedics

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Pediatric proximal femur fractures are rare injuries resulting from high-energy trauma. The Delbet classification is used when describing these injuries, and associates fracture type to the development of avascular necrosis. Historically, casting was utilized in the treatment of these injuries, but high complication rates following this approach have changed the treatment modality to early and anatomic fixation. Complications associated with these injuries including avascular necrosis, non-union, coxa-vara, and premature physeal fusion. Achieving anatomic reduction and performing internal fixation within 24 h from time of injury has become the standard of care in the treatment of pediatric proximal femur fractures.

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Section: Capsular Decompressionmentioning

confidence: 88%

Pediatric proximal femur fractures

Dial

Lark

2018

Journal of Orthopaedics

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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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“…Some scholars have used Kirschner wires into the femoral head to control the displacement of the fracture and successfully reduced an irreducible femoral neck fracture. [3] However, when Kirschner wires are inserted to assist in closed reduction, there is a risk of injury to the femoral artery and vein, the femoral nerve, and lateral femoral cutaneous nerve of the thigh. Injury to the femoral artery may cause complications including life-threatening hemorrhage, hematoma, and pseudoaneurysm.…”

Section: Introductionmentioning

confidence: 99%

A safe percutaneous technique for the reduction of irreducible femoral neck fractures using ultrasound localization of the femoral vascular and nervous structures at the hip

Pandey

et al. 2019

Medicine

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We present a safe percutaneous technique for the placement of Kirschner wires into the femoral head to assist in the reduction of irreducible femoral neck fractures using ultrasound to identify the vascular and nervous structures about the hip. From January 2011 to June 2014, a total of 36 patients (25 males and 11 females) were enrolled in this study. Patients were placed on a fracture reduction table for limb traction. After 3 unsuccessful reductions with limb traction, ultrasound-guided localization of the patient's femoral artery, vein, and nerve at the hip was performed. These structures were marked on the overlying skin and then Kirschner wires were inserted into the femoral head avoiding these marked structures. After the surgery, the Kirschner wire insertions were routinely reviewed by ultrasound, the hip fracture reduction and the femoral nerve sensorimotor function were routinely examined as well. All 36 patients with an irreducible variant of a femoral neck fracture showed anatomic reduction under C-arm fluoroscopy using ultrasound to avoid K wire injury to the femoral vascular structures and nerve. No major vascular injury during operation. In post-surgical ultrasound examination, local hematoma formation was not evident. There was normal function of the femoral nerve. On follow-up, there were no infections, wound problems, recurrence of fracture displacement, laxity, or implant breakage. Preoperative ultrasonic localization of the femoral artery, vein, and femoral nerve safely allowed. Kirschner wire placement under C-arm fluoroscopy into the femoral head to assist in fracture reduction. This assisted reduction method for irreducible femoral neck fractures had a number of advantages, including closed anatomic reduction with minimal attempts, used simple equipment, and avoided further destruction of the blood supply to the femoral head.

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Femoral neck fractures in children and the role of early hip decompression in final outcome

Cited by 38 publications

References 15 publications

Pediatric proximal femur fractures

Pediatric proximal femur fractures

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

A safe percutaneous technique for the reduction of irreducible femoral neck fractures using ultrasound localization of the femoral vascular and nervous structures at the hip

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