COMPLICATIONS AFTER SURGICAL FIXATION OF PEDIATRIC FEMORAL NECK FRACTURES: AN INSTITUTIONAL FIVE-YEAR STUDY

  • Nadeem Ali Govt Medical College Srinagar
  • Mohammad Umar Mumtaz Govt Medical College Srinagar
  • Ibreez Raksan Govt Medical College Srinagar
  • Altaf Ahmed Kawoosa Govt Medical College Srinagar
  • Faisal Naseer Govt Medical College Srinagar
Keywords: femoral neck fracture, Delbet, avascular necrosis, SCFE, non-union

Abstract

Femoral neck fractures in children are very rare and most of the literature is confined to small series. Though it is a rare entity, complications are not uncommon. The aim of this study was to find out the incidence of complications in these fractures in our setting where urgent fixation is not possible. This prospective study was conducted over a period of five years and included 14 patients below 16 years of age managed by internal fixation. The patients were evaluated for demographic data, fracture type, delay in surgical intervention, type of reduction and fixation, and complications. The outcome at final follow up was assessed using Rattlif criteria as good, fair and poor. The age of patients ranged from 3 to 15 years  and Delbet type II was the most common type (n = 9). There was a mean surgical delay of 4.5 days. Avascular necrosis was the most common complication (35.7 %) followed by coxa vara (28.6 %) and limb length discrepancy (28.6 %). One patient had an acute slip of capital epiphysis at six months. At final follow up the results were good in 57.1 %, fair in 14.3 % and poor in 28.6 %. Avascular necrosis (AVN) is the most common and unpredictable complication. Cases that require a reoperation have cent percent chances of developing AVN. SCFE is a rare complication that can be theoretically prevented by supplementing the screws with smooth pins that should cross the growth plate. 

Author Biographies

Nadeem Ali, Govt Medical College Srinagar

Orthopaedics

Consultant

Mohammad Umar Mumtaz, Govt Medical College Srinagar

Associate Professor

Ibreez Raksan, Govt Medical College Srinagar

Junior Resident

Altaf Ahmed Kawoosa, Govt Medical College Srinagar

Professor

References

[1] K Bali, P Sudesh, S Patel, V Kumar, U Saini, MS Dhillon, “Pediatric femoral neck fractures: our 10 years of experience,” Clin. Orthop. Surg., vol. 3(4), pp. 302 -308, Dec 2011.
[2] RT Loder, PW O’Donnell, JR Feinberg, “Epidemiology and mechanisms of femur fractures in children,” J. Pediatr. Orthop., vol. 26(5), pp. 561-566, Sep-Oct 2006.
[3] AH Ratliff, “Fractures of the neck of the femur in children,” J. Bone. Joint. Surg. Br., vol 44-B, pp. 528-542, Aug 1962.
[4] S Hajdu, G Oberleitner, E Schwendenwein, H Ringl, V Vecsei, “Fractures of the head and neck of the femur in children: an outcome study,” Int. Orthop., vol. 35(6), pp. 883-888, Jun 2011.
[5] M Fisher, P Riley, K Bono K, “Femoral Neck fractures in Children,” in Paediatric Orthopedic Trauma Case Atlas, Iobst C, Frick S, Ed. Cham: Springer, 2020.
[6] SA Dhar, MF Ali, TA Dar, A Sultan, MF Butt, AA Kawoosa, MR Mir, “Delayed fixation of the transcervical fracture of the neck of the femur in the pediatric population: results and complications,” J. Child. Orthop., vol. 3(6), pp. 473-477, Oct 2009.
[7] T Palocaren, “Femoral Neck Fractures in Children: A Review,” Indian. J. Orthop., vol. 52(5), pp. 501-506, Sep-Oct 2018.
[8] MA Dendane, A Amrani, ZF El Alami, T El Medhi, H Gourinda, “Displaced femoral neck fractures in children: are complications predictable?” Orthop. Traumatol. Surg. Res., vol. 96(2), pp. 161-165, Apr 2010.
[9] E Forlin, JT Guille, SJ Kumar, KJ Rhee, “Complications associated with fracture of the neck of the femur in children,” J. Pediatr. Orthop., vol. 12(4), pp. 503-509, Jul-Aug 1992.
[10] P Xin, Y Tu, Z Hong, F Yang, F Pang, Q Wei, W He, Z Li, “The clinical and radiological characteristics of avascular necrosis after pediatric femoral neck fracture: a systematic review and retrospective study of 115 patients,” J. Orthop. Surg. Res., vol. 15(1), pp. 520, Nov 2020.
[11] ZZ Dai, ZQ Zhang, J Ding, Z Wu, X Yang, Z Zhang, H Li, “Analysis of risk factors for complications after femoral neck fractures in pediatric patients,” J. Orthop. Surg. Res., vol. 15(1), pp. 58, Feb 2020.
[12] H Li, L Zhao, L Huang, KN Kuo, “Delayed slipped capital femoral epiphysis after treatment of femoral neck fracture in children,” Clin. Orthop. Relat. Res., vol. 473, pp. 2712-2717, Aug 2015.
[13] H Bombaci, T Centel, A Babay, IM Turkmen, “Evaluation of complications of femoral neck fractures in children operated on at least 24 hours after initial trauma,” Acta. Orthop. Traumatol. Turc., vol. 40(1), pp. 6-14, 2006.
[14] SK Yadav, AC Agarwal, BK Kar, HS Sakale, B Sahoo, RK Chandan, “Pediatric fracture neck of femur,” J. Orthop. Dis. Traumatol., vol. 1(1), pp. 11-14, 2018.
[15] KS Song, SW Lee, “Subtrochanteric femur fracture after removal of screws for femoral neck fracture in a child,” Am. J. Orthop., vol. 44(1), pp. 40-42, Jan 2015.
[16] JT Patterson, J Tangtiphaiboontana, NK Pandya. Management of pediatric femoral neck fracture. J. Am. Acad. Orthop. Surg., vol. 26(12), pp. 411-419, Jun 2018.
[17] JB Yaokreh, TH Odehouri-Koudou, GA Dieth, S Tembely, YG Kouame, BD Kouame, O Ouattara, “Management of femoral neck fractures in children: experience of a short series in a developing country,” Afr. J. Paediatr. Surg., vol. 15, pp. 114-117, Apr-Jun 2018.
[18] H Cici, S Kilic, “Closed reduction and cannulated screw fixation for pediatric femoral neck fractures,” Turk. J. Hip. Surg., vol. 1(1), pp. 21-26, 2021.
[19] ES Moon, CT Mehlman, “Risk factors for avascular necrosis after femoral neck fractures in children: 25 Cincinnati cases and meta-analysis of 360 cases,” J. Orthop. Trauma., vol. 20(5), pp. 323-329, May 2006.
[20] MQ Azam, A Iraqi, M Sherwani, M Abbas, A Alam, AB Sabir, N Asif, “Delayed fixation of displaced type II and III pediatric femoral neck fractures,” Indian. J. Orthop., vol. 43(3), pp. 253-258, Jul 2009.
[21] C Wu, B Ning, P Xu, J Song, D Wang, “Efficacy and complications after delayed fixation of femoral neck fractures in children,” J. Orthop. Surg. (Hong Kong)., vol.28(1), pp. 1-6, Jan-Apr 2020.
[22] U Inan, N Kose, H Omeroglu, “Pediatric femur neck fractures: a retrospective analysis of 39 hips,” J. Child. Orthop., vol. 3(4), pp. 259-264, Aug 2009.
[23] KA Singh, V Chandankere, H Shah, “Does the timing of treatment affect complications of pediatric femoral neck fractures?” J. Orthop., vol. 22, pp. 207-212, May 2020.
[24] JD Stone, MK Hill, Z Pan, EN Novais, “Open reduction of pediatric femoral neck fractures reduces osteonecrosis risk,” Orthopaedics., vol. 38(11), pp. e983-e990, Nov 2015.
[25] M Nayeemuddin, GA Higgins, E Bache, J O’hara, P Glitheroe, “Complication rate after operative treatment of pediatric femoral neck fractures,” J. Pediatr. Orthop. B., vol. 18(6), pp. 314-319, Nov 2009.
[26] SF Lam, “Fractures of the neck of the femur in children,” J. Bone. Joint. Surg. Am., vol. 53(6), pp. 1165-1179, Sep 1971.
[27] T Mirdad, “Fractures of the neck of femur in children. An experience at the Aseer Central Hospital, Abha, Saudi Arabia,” Injury., vol. 1, pp. 823-827, Nov 2002.
[28] FC Kuo, SJ Kuo, JY Ko, “Overgrowth of the femoral neck after hip fractures in children,” J. Orthop. Surg. Res., vol. 11(1), pp. 50, Apr 2016.
[29] S Ersozlu, C Ozturk, B Sarisozen, “Slipped capital femoral epiphysis after ipsilateral femoral neck fracture in an 11-year-old girl,” Injury. Extra., vol. 36, pp. 303-305, 2005.
[30] H Li, L Zhao, L Huang, KN Kuo, “Delayed slipped capital femoral epiphysis after treatment of femoral neck fracture in children,” Clin. Orthop. Relat. Res., vol. 473(8), pp. 2712-2717, Aug 2015.
[31] MA Chinoy, S Pal, MA Khan, “Slipped capital femoral epiphysis after treatment of femoral neck fracture,” Pak. J. Med. Sci., vol. 36(1), pp. S94-S97, Jan 2020.
[32] NR Gopinathan, D Chouhan, N Akkina, P Behera, “Case report: bilateral femoral neck fractures in a child and a rare complication of slipped capital epiphysis after internal fixation,” Clin. Orthop. Relat. Res., vol. 470, pp. 2941-2945, Oct 2012.
[33] ST Jung, GH Park, “Slipped capital femoral epiphysis following fracture of the femoral neck: a case report,” J. Pediatr. Orthop. B. vol. 21(6), pp. 579-582, Nov 2012.
[34] O Lahoti, TJ Turnbull, BL Hinves, “Seperation of the proximal femoral epiphysis after derotation varus osteotomy of the femur,” J. Pediatr. Orthop., vol. 18, pp. 662-664, Sep-Oct 1998.
[35] AP Sakamoto, LL Ramos, R Fernandes Ada, MT Terreri, “Chondrolysis of the hip in an adolescent: clinical and radiological outcomes,” Rev. Bras. Reumatol., vol. 53(2), pp. 215-218, Apr 2013.
[36] AE Bagatur, G Zorer, “Complications associated with surgically treated hip fractures in children,” J. Pediatr. Orthop. B., vol. 11, pp. 219-228, Jul 2002.
Published
2021-12-12
How to Cite
[1]
N. Ali, M. Mumtaz, I. Raksan, A. Kawoosa, and F. Naseer, “COMPLICATIONS AFTER SURGICAL FIXATION OF PEDIATRIC FEMORAL NECK FRACTURES: AN INSTITUTIONAL FIVE-YEAR STUDY”, JSS, vol. 8, no. 3, Dec. 2021.