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Proximal femoral and neck fracture in children with healthy and pathological bone - Controversies of treatment.

AIM. Femoral neck fractures (FNF) are rare in children and adolescents. Treatment of FNF in this age group warrants particular concern due to special morphology, biomechanics and frequency of serious complications. This case series reviews the treatment and outcomes of treatment of FNF in children and adolescent at our Department. MATERIALS AND METHODS. We retrospectively reviewed the medical records and assessed clinical outcomes and radiographic results of 31 patients treated for FNF at our Department in a 27-year period. RESULTS. Nineteen patients presented (11 F, 8 M) with FNF of healthy bone and 12 patients (3 F, 9 M) with a pathological fracture (PF). Follow up ranged from 4 to 16 years. In the group with otherwise healthy bone, 5 patients had a good final result after primary treatment. Fourteen patients received secondary treatment due to twenty-seven complications. Results of secondary treatment were good in five, fair in six and poor in three patients. Pauwels abduction osteotomy was effective in the treatment of residual non-union, delayed union and coxa vara. In patients with FNF in pathologically altered bone, the final outcome was influenced by the size of the cyst (weak bone) and amount of available healthy bone for implant purchase. Stabilization of the fracture fragments was achieved in all patients. No patients had damage to the epiphysis. However, treatment was prolonged due to size of the cyst. In two patients secondary procedure was necessary. In three patients healing of the cyst was not complete at the last follow up. CONCLUSION. In FNF of pediatric age special attention to details is mandatory. FNF of normal bone is usually a result of high-energy trauma and as such should be considered an emergency. Pathological FNF can pose a diagnostic problem, with the primary pathology concealed before biopsy, but the primary issue is stabilization of fracture.

femoral neck ; proximal femur ; pathological bone ; healthy bone ; treatment

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