[Final results of the operatively treated femoral neck fractures in children and adolescents].

Abstract

Background: Femoral neck fractures in children occur 130 times more seldom than in adult's population. According to specific vascularisation the most common complication is avascular necrosis (AVN) of the femoral head. Purpose of the study was the treatment's results analysis of the 15 children and adolescent's femoral neck fractures.

Methods: 15 patients at a mean age of 12.7 years (5-17 years) presenting with femoral neck fractures were analyzed. On the pre- and postoperatively X-rays we have determined the type of fracture in Delbet classification and compared femoral-neck angle with the healthy side. In the final clinical examination ROM, the equality of leg's length and quality of walking were checked. The results were determined in the Harris hip score and Ratliff score. We divided the patients into 3 groups that depended on the time of surgery: 1) operated up to 24 hours after injury (6 patients), 2) 24-72 hours post fracture (5), 3) after 72 hours (4).

Results: 10 fractures were classified to type 2, 3 fractures to type 3 according to Delbet scale (X-rays of 2 patients are missed). The final outcome after 7-163 months (57 on average) could be precised at 13 patients. Significant ROM decreasing was confirmed in 4 patients. The highest restriction was noticed in internal rotation (on average 14 degrees comparing with the healthy side). Other motions were slightly restricted. Inequality of limb's length amounted 0.5 cm on average. The average Harris hip score amounted 92.58 (76-100). The final results were assessed as very good at 8 patients, good at 4 and moderate in 1 patient. We haven't noticed bad results. AVN were suspected in 3 patients, 2 of them were scintigraphically confirmed.

Conclusions: In order to avoid AVN the most important thing is an early (up to 24 hours since the injury) anatomic reposition and proper bone fragments stabilization.