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Treatment analysis of paediatric femoral neck fractures: a prospective multicenter theraupetic study in Indian scenario

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Abstract

Purpose

Paediatric femur neck fractures are exceedingly rare owing to dense bone surrounded by a strong periosteum; they account for 1 % of paediatric fractures and are usually associated with high energy trauma.

Methods

This was a prospective multicenter therapeutic study on pediatric femoral neck fractures from June 2004 to September 2013 at three centres in Odisha, India. Children with femoral neck fractures (Delbet type 2 and 3) who were operated and completed a minimum one-year follow-up were included. We divided the neck of femur (100 %) into four zones (25 % each), with zone I being highly unstable and zone IV being most stable. Implants for fixation, as suggested by pre-operative zone distribution, were used.

Results

Twenty-eight children were studied with mean two- to seven-year follow-up. In 23 children cancellous screws were used. In zone I Smooth Moore’s pins that crossed the epiphysis were the implant of choice. Causes were avascular necrosis (14.2 %), nonunion (7.14 %) and one case of implant failure, while coxa vara was encountered in two instances. Functional results (Ratliff’s criteria) were good in 82.1 %, fair in 7.1 % and poor in 10.7 % of patients; the mean IOWA hip scores were 96, 94 and 98, respectively.

Conclusion

Early surgical intervention hastens recovery, rehabilitation and return to school and decreases the risk of developing avascular necrosis. We suggest Smooth Pins fixation in zones I and II (nearer to zone I) and cancellous screw fixation in zones II, III and IV. Decompression of hip joint by capsulotomy releases the tamponade effect and should be performed in all cases of paediatric femoral neck fractures.

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References

  1. Quick TJ, Eastwood DM (2005) Pediatric fractures and dislocations of the hip and pelvis. Clin Orthop 432:87–96

    Article  PubMed  Google Scholar 

  2. Meyers MH (1985) Fractures of the hip. Year Book Medical Publishers, Chicago

    Google Scholar 

  3. Ratliff AH (1962) Fractures of the neck of the femur in children. J Bone Joint Surg (Br) 44(3):528–542

    Google Scholar 

  4. Hamilton CM (1961) Fractures of the neck of the femur in children. JAMA 178(8):799–801

    Article  CAS  PubMed  Google Scholar 

  5. Cheng JC, Tang N (1999) Decompression and stable internal fixation of femoral neck fractures in children can affect the outcome. J Pediatr Orthop 19(3):338–343

    CAS  PubMed  Google Scholar 

  6. Sferopoulos NK, Papavasiliou VA (1994) ‘Natural’ healing of hip fractures in childhood. Injury 25(8):493–496

    Article  CAS  PubMed  Google Scholar 

  7. Davison BL, Weinstein SL (1992) Hip fractures in children: a long term follow-up study. J Pediatr Orthop 12(3):355–358

    Article  CAS  PubMed  Google Scholar 

  8. Colonna PC (1929) Fractures of the neck of the femur in children. Clin Orthop 6:793–797

    Google Scholar 

  9. Canale ST, Beaty JH (1996) Pelvic and hip fractures. In Rockwood CA, Wilkins KE, Beaty JH (Eds) Fractures in children, 4th edn. Lippincot Raven, Philadelphia, pp 1109–1193

  10. Heiser JM, Opphenheim WL (1980) Fracture of the hip in children; a review of 40 cases. Clin Orthop 12:355–358

    Google Scholar 

  11. Pring ME, Rang MR, Wenger DR (2005) Pelvis and hip. In: Rang MR, Pring M, Wenger DR (eds) Rang’s children’s fractures, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, pp 165–179

    Google Scholar 

  12. Ng GP, Cole WG (1996) Effect of early hip decompression on the frequency of avascular necrosis in children with fractures of the neck of the femur. Injury 27(6):419–421

    Article  CAS  PubMed  Google Scholar 

  13. Azam M, Iraqi AA, Sherwani MKA, Abbas M, Alam A, Sabir AB, Asif N (2009) Delayed fixation of displaced type II and III pediatric femoral neck fractures. Indian J Orthop 43(3):253–258

    Article  PubMed Central  PubMed  Google Scholar 

  14. Magu NK, Sing R, Sharma AK, Ummat V (2007) Modified Powel’s intertrochanteric osteotomy in neglected femoral fractures in children: a report of 10 cases followed for a minimum of five years. J Orthop Trauma 21:237–243

    Article  PubMed  Google Scholar 

  15. Nagi ON, Dhillon MS, Gill SS (1992) Fibular osteosynthesis in delayed type II and type III femoral neck fractures in children. J Orthop Trauma 6:306–313

    Article  CAS  PubMed  Google Scholar 

  16. Huang C-H (1986) Treatment of neglected femoral neck fractures in young adults. Clin Orthop Relat Res 206:117–126

    PubMed  Google Scholar 

  17. Canale ST (1990) Fractures of the hip in children and adolescents. Orthop Clin N Am 21:341–352

    CAS  Google Scholar 

  18. Lam SF (1971) Fractures of the neck of the femur in children. J Bone Joint Surg Am 53(6):1165–1179

    CAS  PubMed  Google Scholar 

  19. Davison BL, Weinstein SL (1992) Hip fractures in children. A long-term follow up study. J Paediatr Orthop 12:355–358

    Article  CAS  Google Scholar 

  20. 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(5):323–329

    Article  PubMed  Google Scholar 

  21. Togrul E, Bayram H, Gulsen M, Kalaci A, Ozbarlas S (2005) Fractures of the femoral neck in children: long-term follow-up in 62 hip fractures. Injury 36(1):123–130

    Article  PubMed  Google Scholar 

  22. Hughes LO, Beaty JH (1994) Fractures of head and neck of femur in children; current concepts review. J Bone Joint Surg Am 76:283–292

    CAS  PubMed  Google Scholar 

  23. Mirdad T (2002) Fractures of neck of femur in children. An experience at Aseer Central Hospital, Abha, Saudi Arabia. Injury 33:823–827

    Article  PubMed  Google Scholar 

  24. Tachdijian MO (1990) Fractures of neck of femur. Pediatric Orthopaedics, second edn. WB Saunders Co., Philadelphia, pp 3231–3247

  25. Trueta J (1957) The normal vascular anatomy of human femoral head during growth. J Bone Joint Surg (Br) 39:358–394

    Google Scholar 

  26. Bali K, Sudesh P, Patel S, Kumar V, Saini U, Dhillon MS (2011) Pediatric femoral neck fractures: our 10 years of experience. Clin Orthop Surg 3:302–308

    Article  PubMed Central  PubMed  Google Scholar 

  27. Swiontkowski MF, Winquist RA (1986) Displaced hip fractures in children and adolescent. J Trauma 26:384–388

    Article  CAS  PubMed  Google Scholar 

  28. Flynn JK, Wong KL, Yeh GL, Meyer JS, Davidson RS (2002) Displaced fractures of the hip in children. J Bone Joint Surg (Br) 84:108–112

    Article  CAS  Google Scholar 

  29. Pforringer W, Rosemeyer B (1980) Fractures of the hip in children and adolescents. Acta Orthop Scand 51(1):91–108

    Article  CAS  PubMed  Google Scholar 

  30. Song KS, Kim YS, Sohn SW, Ogden JA (2001) Arthrotomy and open reduction of the displaced fracture of the femoral neck in children. J Pediatr Orthop B 10(3):205–210

    CAS  PubMed  Google Scholar 

  31. Song KS (2010) Displaced fracture of the femoral neck in children: open versus closed reduction. J Bone Joint Surg (Br) 92(8):1148–1151

    Article  Google Scholar 

  32. Ingram AJ, Bachynski B (1953) Fractures of the hip in children; treatment and results. J Bone Joint Surg Am 35(4):867–887

    PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Orthopaedics, Hi-Tech Medical College & Odisha, Flat No.12, Block-I, Hi-Tech Medical College Campus, Health Park, Pandara, Bhubaneswar, 751025, India

    Ranajit Panigrahi, Nishit Palo & Ashok Priyadarshi

  2. Department of Orthopaedics, SCB Medical College, Odisha, India

    Biswajit Sahu & Manas Ranjan Biswal

  3. Department of Physiology, Hi-Tech Medical College & Odisha, Odisha, India

    Amita Kumari Mahapatra

Authors
  1. Ranajit Panigrahi
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  2. Biswajit Sahu
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  3. Amita Kumari Mahapatra
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  4. Nishit Palo
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  5. Ashok Priyadarshi
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  6. Manas Ranjan Biswal
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Correspondence to Ranajit Panigrahi.

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Panigrahi, R., Sahu, B., Mahapatra, A.K. et al. Treatment analysis of paediatric femoral neck fractures: a prospective multicenter theraupetic study in Indian scenario. International Orthopaedics (SICOT) 39, 1121–1127 (2015). https://doi.org/10.1007/s00264-015-2677-y

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  • DOI: https://doi.org/10.1007/s00264-015-2677-y

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