Skip to main content

Advertisement

SpringerLink
Log in

Operative treatment of avascular necrosis of the femoral head after proximal femur fractures in adolescents

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Our aim was to assess operative treatment for post-traumatic avascular necrosis of the femoral head (ANFH) in adolescents.

Methods

Eleven patients with an average age of 17 (range 14–26) years were operated up on for ANFH after proximal femoral fractures. The average interval between injury and reconstructive surgery was four (range two to eight) years. The average follow-up of the entire cohort was 89 (range 48–132) months. Five patients with total ANFH were treated by total hip replacement (THR). Six patients with partial ANFH were treated with valgus intertrochanteric osteotomy (VITO).

Results

In all patients, operation improved hip function. The average preoperative Harris Hip Score (HHS) was 70 points and average postoperative HHS was 97 points. Comparison of magnetic resonance imaging (MRI) scans before and after VITO demonstrated resorption of the necrotic segment of the femoral head and its remodelling in all six patients with partial ANFH. A complication was encountered in one patient.

Conclusion

Patients treated for ANFH had good medium-term outcomes after THR for total necrosis and also after VITO for partial necrosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Ingram JA, Bachynski B (1953) Fractures of the hip in children. J Bone Joint Surg Am 35-A:867–886

    PubMed  CAS  Google Scholar 

  2. Kay SP, Hall JE (1971) Fracture of the femoral neck in children and its complications. Clin Orthop Relat Res 92:155–188

    Google Scholar 

  3. Miller WE (1973) Fractures of the hip in children from birth to adolescence. Clin Orthop Relat Res 80:53–71

    Google Scholar 

  4. Canale ST, Bourland WL (1977) Fracture of the neck and intertrochanteric region of the femur in children. J Bone Joint Surg Am 59-A:431–443

    Google Scholar 

  5. Morrissy R (1980) Hip fractures in children. Clin Orthop Relat Res 152:202–210

    PubMed  Google Scholar 

  6. Hughes LO, Beaty JH (1994) Fractures of the head and neck of the femur in children. J Bone Joint Surg Am 76-A:283–292

    Google Scholar 

  7. Boardman MJ, Herman MJ, Buck B, Pizzutillo PD (2009) Hip fractures in children. J Am Acad Orthop Surg 17:162–173

    PubMed  Google Scholar 

  8. Pape H-C, Krettek C, Friedrich A, Pohlemann T, Simon R, Tscherne H (1999) Long-term outcome in children with fractures of the proximal femur after high-energy trauma. J Trauma 46:58–64

    Article  PubMed  CAS  Google Scholar 

  9. Moon ES, Mehlman CT (2006) Risk factors for avascular necrosis after femoral neck fractures in children: 25 Cincinnati cases and meta-analysis of 360 cases. J Orthop Trauma 20:323–329

    Article  PubMed  Google Scholar 

  10. Swiontkowski MF (1989) Complications of hip fractures in children. Complicat Orthop 4:58–64

    Google Scholar 

  11. Morsy HA (2001) Complications of fracture of the neck of the femur in children. A long-term follow-up study. Injury 32:45–51

    Article  PubMed  CAS  Google Scholar 

  12. Ratliff AHC (1962) Fractures of the neck of the femur in children. J Bone Joint Surg Br 44-B:528–542

    PubMed  CAS  Google Scholar 

  13. Axhausen G (1924) Epiphyseonekrose und Arthritis deformans. Arch Klin Chir 126:341–363

    Google Scholar 

  14. Whitman R (1902) A new method of treatment for fracture of the neck of the femur, together with remarks on coxa vara. Ann Surg 36:746–761

    Article  PubMed  CAS  Google Scholar 

  15. Boitzy A (1971) La fracture du col du femur chez l´enfant et l´adolescent. Mason, Paris

    Google Scholar 

  16. Forlin E, Guille JT, Kumar SJ, Rhee KJ (1992) Complications associated with fracture of the neck of the femur in children. J Pediatr Orthop 12:503–509

    Article  PubMed  CAS  Google Scholar 

  17. Ko J-Y, Meyers MH, Wenger DR (1995) “Trapdoor” procedure for osteonecrosis with segmental collapse of the femoral head in teenagers. J Pediatr Orthop 15:7–15

    PubMed  Google Scholar 

  18. Nötzli HP, Chou LB, Ganz R (1995) Open-reduction and intertrochanteric osteotomy for osteonecrosis and extrusion of the femoral head in adolescents. J Pediatr Orthop 15:16–20

    Article  PubMed  Google Scholar 

  19. Abbas AA, Yoon TR, Lee JH, Hur CI (2008) Posttraumatic avascular necrosis of the femoral head in teenagers treated by a modified transtrochanteric rotational osteotomy: a report of three cases. J Orthop Trauma 22:63–69

    Article  PubMed  Google Scholar 

  20. Linhart W, Stampfel O, Ritter G (1984) Posttraumatische Femurkopfnekrose nach Trochanterfraktur. Z Orthop 122:766–769

    Article  PubMed  CAS  Google Scholar 

  21. Bartoníček J, Skála-Rosenbaum J, Douša P (2003) Valgus intertrochanteric osteotomy for malunion and nonunion of trochanteric fractures. J Orthop Trauma 17:606–612

    Article  PubMed  Google Scholar 

  22. Schatzker J (ed) (1984) The intertrochanteric osteotomy. Springer, Berlin

    Google Scholar 

  23. Bosworth DM, Fielding JW, Ishizuka T, Ege R (1961) Hip-shelf operation in adults. J Bone Joint Surg Am 43-A:93–106

    Google Scholar 

  24. Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51-A:737–755

    Google Scholar 

  25. Stover M, Beaulé PE, Matta JM, Mast JW (2004) Hip arthrodesis: a procedure for the new millennium? Clin Orthop Relat Res 418:126–133

    Article  PubMed  Google Scholar 

  26. Schafroth MU, Blokzijl RJ, Haverkamp D, Maas M, Marti RK (2010) The long-term fate of the hip arthrodesis: does it remaina valid procedure for selected cases in the 21st century? Int Orthop 34:805–810

    Article  PubMed  Google Scholar 

  27. Haverkamp D, Eijer H, Besselaar PP, Marti RK (2008) Awareness and use of intertrochanteric osteotomies in current clinical practice. An international survey. Int Orthop 32:19–25

    Article  PubMed  CAS  Google Scholar 

  28. Zweifel J, Wolfgang Hönle W, Alexander Schuh A (2011) Long-term results of intertrochanteric varus osteotomy for dysplastic osteoarthritis of the hip. Int Orthop 35:9–12

  29. Said GZ, Farouk O, Said HGZ (2010) Valgus intertrochanteric osteotomy with single-angled 130° plate fixation for fractures and non-unions of the femoral neck. Int Orthop 34:1291–1295

    Article  PubMed  Google Scholar 

Download references

Acknowledgement

This study was supported by a grant of the Ministry of Health of the Czech Republic Grant IGA MZ: NS 9980–3 Importance of intertrochanteric osteotomy and acetabular coverage procedures in adolescents and adults for preservation of long-term hip function.

Author information

Authors and Affiliations

  1. Department of Surgery of the 1st Faculty of Medicine, Charles Univeristy, Thomayer University Hospital, Vídeňská 800, 142 00, Prague-4, Czech Republic

    Jan Bartoníček

  2. Orthopaedic Department of 3rd Faculty of Medicine of Charles University, Prague, Czech Republic

    Jaroslav Vávra & Radek Bartoška

  3. Department of Pediatric Surgery and Traumatology of 3rd Faculty of Medicine of Charles University, Prague, Czech Republic

    Petr Havránek

Authors
  1. Jan Bartoníček
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jaroslav Vávra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Radek Bartoška
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Petr Havránek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jan Bartoníček.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bartoníček, J., Vávra, J., Bartoška, R. et al. Operative treatment of avascular necrosis of the femoral head after proximal femur fractures in adolescents. International Orthopaedics (SICOT) 36, 149–157 (2012). https://doi.org/10.1007/s00264-011-1272-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-011-1272-0

Keywords

Search

Navigation