Naslov
Treatment of the Complications following Femoral Neck Fracture in Children

Autori
Antičević, Darko

Izvornik
Acta chirurgiae orthopaedicae et traumatolgiae Čechoslovaca (0001-5415) 71 (2004); 15-15

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, ostalo

Ključne riječi
Femoral neck ; fracture ; complications ; children

Sažetak
Aim: To report results of treatment of the complications following femoral neck fracture in nineteen children. The special emphasis was paid to the influence of type of the secondary treatment on the hip joint final outcome. Patients and Methods: All patients treated during period form 1972 till 1991 were retrospectively reviewed. Patients younger then five and older then sixteen years as well as patients with pathological fracture were excluded from the study. Classification according to Delbet was utilized for this review. Transepiphyseal (type I) and peritrochanteric (type IV) fracture were excluded because in strictly anatomical sense these types are not femoral neck fractures. Nineteen patients (11 girls and 8 boys) with nineteen femoral neck fractures formed the basis of the study. There were eight transcervical (type II) and eleven baseocervical (type III) fractures. In ten patients injury occurred in motor vehicle accident (MVA), and nine patients fracture resulted falling from height. At the time of fracture, average patient’s age was 10 years and 11 months (range: 6 to 14 years ; median: 11 years). To five patients treatment was given in our institution and fourteen patients were referred to the Unit after primary treatment elsewhere. All five patients primary treated in our Unit were subjected to open reduction of the fracture and internal fixation. Of the fourteen patients with secondary treatment in our Unit twelve had Pauwels abduction femoral osteotomy. Indications were non-union/delayed union and coxa vara associated with avascular necrosis (AVN) in some patients. One patient had adduction femoral osteotomy and one patient had epiphyseodesis of the femoral head as the secondary procedure. Over-all final results and the extent of AVN were classified according to Ratliff. Results: Follow-up ranged from four to sixteen years and majority of the patients were followed to skeletal maturity. Five patients had good final results – all had open reduction and internal fixation as a primary surgical intervention. However, two patients had premature epiphyseal closure which did not significantly influence the final result. Secondary treatment in fourteen patients was indicated due to twenty-seven complications. Two or more complications were found in ten patients. Following complications were encountered: chondrolysis in one patient ; AVN in six ; non-union/delayed union in six patients ; coxa vara in eight patients ; coxa brevis and premature epiphyseal closure in five patients ; epiphyseolysis in one patient. Pauwels abduction femoral ostetomy was successful in correction of coax vara and non-union but did not improve status of femoral head avascular necrosis. However, in one patient type II of AVN was deteriorated by femoral abduction osteotomy. In four patients with type III AVN result of femoral abduction osteotomy was development of coxa brevis. In one patient femoral lengthening procedure (Wagner) was done to premature epiphyseal closure with five centimetres of shortenig. In another patient slipped capital femoral epiphysis occurred three months after femoral neck fracture, and secondary epiphyseodesis was performed. In all fourteen patients after secondary surgical procedure results were good in five, fair in six and poor in three patients. Conclusion: For the treatment of sequelae following femoral neck fracture in children the most common secondary procedure was Pauwels abduction osteotomy. This procedure was effective in the treatment of non-union, delayed union and coxa vara, but did not alter outcome of avascular necrosis of the femoral head and neck.

Izvorni jezik
Engleski

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