Types and complications of femoral neck fractures in children

Abstract

This multicenter collaborative study was undertaken to review the types and complications of femoral neck fractures in children. It is a retrospective clinical and radiological review of 108 femoral neck fractures. Cases originated from four different pediatric hospitals. All the patients had plain radiographs. Fractures occurred at all ages (one day to 18 years), and 63% of the patients were boys. Forty-nine fractures were traumatic; 37 were pathologic, 19 were insufficiency fractures; and three were fatigue fractures. Unless the underlying bone was abnormal, significant high velocity trauma, fall from a height or other severe violence was required to fracture the femoral neck. A unicameral bone cyst was the underlying lesion in 40% of pathologic femoral neck fractures and malignancy in 35%. Osteoporosis as in myelodysplasia, osteogenesis imperfecta and from other causes was responsible for 52% of insufficiency fractures. Because of the unique osseous and vascular anatomy of the femoral head and neck in the growing child, these fractures have a high incidence of complications. Complications included avascular necrosis 13%, premature closure of the epiphyseal plate 12%, varus deformity 8.3%, and nonunion 3.7%. Unless there is a clear history of significant violence, a cause for a femoral neck fracture should be sought, e.g. an underlying bone lesion or a metabolic bone disease. These fractures are rare, but are serious injuries since their complications may lead to a life-long disability.

Management pitfalls of fractured neck of femur in osteogenesis imperfecta

“…AVN, coxa vara, premature physeal closure, limb length discrepancy and non-union. The incidence of AVN varies from 13 to 45 % [11,[18][19][20]. All hip joints from our series remained congruent post-operatively and none of the fractures developed AVN.…”

Screw Osteosynthesis of Proximal Femur Fractures in Children

“…mit einer zusätzlichen äußeren Ruhigstellung. M/3-Frakturen behandelt man heute mit einer elastisch-stabilen intramedullären Nagelung oder Plattenosteosynthese (Abbildungen 2 bis 4) [1,22,23]. Nach M/3-Frakturen treten keine Femurkopfnekrosen auf.…”

“…Shrader et al zeigten in einer sehr genauen Analyse von 360 Patienten, dass die Gefahr der avaskulären Nekrose nur von Frakturtyp und Alter abhängig ist. Eine avaskuläre Nekrose kommt bei E/1-Frakturen 15-mal, bei M/1-Frakturen sechsmal und bei M/2-Frakturen viermal häufiger als bei M/3-Frakturen vor[1,2,5,7,9,11,15,21].Proximale Femurfrakturen vom Typ M/1 und M/2 müssen immer operiert werden, da selbst vermeintlich stabile Frakturen sekundär dislozieren können (Abbildung 6).…”

Femoral neck fractures in osteogenesis imperfecta patients: A retrospective case series and novel surgical technique

“…Frequent complications of these fractures include avascular necrosis, coxa vara, premature physeal closure, and leg length discrepancy. [5] Treatment of femoral neck fractures in young patients with OI are rarely reported in the literature. There are additional factors that complicate surgical management in this patient population including poor bone quality, difficult radiographic visualization of the proximal femur secondary to deformity and severe osteoporosis, small patient size, and the frequency of preexisting implants.…”