- Timing:
- references:
-
Decompression and stable internal fixation of femoral neck fractures in children can affect the outcome.
-
Femoral Neck Fractures in Pediatric Patients: 30 Years Experience at a Level 1 Trauma Center.
-
Fractures of the hip in children and adolescents.
-
associated injuries:
- trauma to
triradiate cartilage or hemipelvis;
- Fracture Subtypes:
-
type I transepiphyseal separation:
- according to
Moon et al the rate of AVN was 38%;
-
transepiphyseal fracture of the femoral neck.
-
type II, transcervical fractures:
- most common type, accounting for about 50% of pediatric hip fractures;
- most of these are displaced (80%) which relates directly to development of AVN;
- rate of AVN is approx 28-50%, and it is controversial as to whether emergent reduction and internal fixation will decrease probability of AVN;
- according to
Moon et al the rate of AVN was 28%;
- internal fixation is recommended for all type II frx because most are unstable;
- it is controversial as to whether pins should cross the physis;
- w/o internal fixation, both displaced and non displaced transcervical type II frxs tend to drift into
coxa vara;
- in young children, consider use of two pins, but otherwise use three pins;
- because of numerous problems w/ non compliance, a
spica cast w/ the hip abducted is used for 6 weeks;
- indications for preoperative hip aspiration (or
intra-operative capsulotomy) remain unclear;
- references:
-
Fractures of the femoral neck in childhood. Results of conservative treatment.
-
type III: cervicotrochanteric fractures:
- accounts for about 31% of pediatric hip fractures;
- about one half of these frxs are displaced at the time of diagnosis;
- similar to those occuring at base of femoral neck in adult, although AVN is more common in this fracture in child than in the adult;
- according to
Moon et al the rate of AVN was 18%;
- if frx is non displaced then consider several weeks of traction followed by abduction
spica cast;
- a displaced frx requires closed reduction and internal fixation w/ pins;
- it is controversial as to whether pins should cross the physis;
-
type IV: intertrochanteric fracture:
- least common;
- these result in the fewest complications;
- in the trochanteric area, rapid union usually occurs, within 6 weeks;
- according to
Moon et al the rate of AVN was 5%;
- subtrochanteric fractures:
-
Management of subtrochanteric fractures in skeletally immature adolescents.
-
Fracture of the neck and intertrochanteric region of the femur in children.
- Complications: AVN (see
avascular necrosis of the hip in adults)
- references:
- Effect of early hip decompression on the frequency of AVN in chidlren with fractures of the neck of the femur. GP Ng and WG Cole.
- Injury. Vol 27(6). 1996. 419-421.
-
Risk factors for avascular necrosis after femoral neck fractures in children: 25 Cincinnati cases and meta-analysis of 360 cases.
- Complications associated with fracture of the neck of the femur in children. E. Forlin et al. JPO. Vol 12(4) 1992. p 503-509.
-
Effect of early hip decompression on the frequency of avascular necrosis in children with fractures of the neck of the femur.
Current Concepts Review. Fractures of the Head and Neck of the Femur in Children.
Fractures of the hip in children and adolescents. ST Canale. Orthop. Clin. North Am. Vol 21. 1990. p 341-352.
Displaced hip fractures in children and adolescents
Fracture of the neck and intertrochanteric region of the femur in children.
Hip injuries in children and adolescents.
Fractures of the hip in children and adolescents.
Long-term follow-up of children with femoral neck fractures. Leung PC, Lam SF: J Bone Joint Surg 1986;68B:537-540.
Hip fractures in children: A long term follow up study. BL Davison and SL Weinstein. J. Pediatric Orthop. Vol 12. 1992. p 355-358.
Arthrotomy and open reduction of the displaced fracture of the femoral neck in children.
Fractures of the neck of femur in children: an experience at the Aseer Central Hospital, Abha, Saudi Arabia.
Fractures of the hip in children and adolescents.
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