Complications after Hip Fracture in Children

Kim, Hui Taek; Lee, Choon Key; Yoo, Chong Il

Abstract

PURPOSE
To analyze complications and their effects on prognoses of children hip fractures.
MATERIALS AND METHODS
26 childhood hip fractures (6 type I, 7 type II, 10 type III, 3 type IV) were studied for 11 years (1986-1997) . We analyzed factors possibly related to complications and their effects on prognoses, especially avascular necrosis (AVN) of the femoral head.
RESULTS
Of 26 patients, there were 7 AVN (27%) , 2 nonunions (8%) , 3 coxa vara (12%) , 9 premature epiphyseal closures (35%) , and 2 infections (8%) . Of 7 patients with AVN, 3 patients had type I fracture and 4 patients had type II fracture. No AVN developed in type III and IV fractures. Of 2 patients who had type I fracture with dislocation, all patients had AVN (100%) . Four of 14 patients who had displacement of the fracture site and one in 10 patients who had non-displacement fracture developed AVN. In our study of the incidence of AVN according to surgical reduction time after injury, 3 (60%) of 5 patients who were treated by surgical reduction within 6 hours and 4 (19%) out of 21 patients who were treated by surgical reduction after 6 hours developed AVN.
CONCLUSION
In childhood hip fracture, surgical reduction time after trauma (<6 hours) did not seem to be a critical factor in preventing AVN. Force of injury and level of fracture site which jeopardize the blood supply to the femoral head were important factors. Age at time of injury was also important. Containment treatment of younger children (<10 years) and surgical treatment of older children (>10 years) were found to be an effective treatment of AVN. AVN concomitant with pyogenic infection had the worst prognosis.