A Clinical Study on the Fractures of the Femoral Neck in Children

Hahn, Soo Bong; Kim, Nam Hyun; Shin, Jung Soon; Song, Seung Keun

Abstract

The femoral neck in children is dense and is small in diameter and its periosteum is thicker and stronger than that of an adult. Thus, fractures of the femoral neck in children, unlike the 60-year-old woman, are rare and usually require severe violence and this accounts for the high frequency of associated injuries. Since these fractures are rare and the femoral neck in children has many anatomic and physiologic differences, we have to consider some factors that work against treatment of these fractures. Twenty seven cases of fractures of the femoral neck in children which were treated at Severance Hospital, Yonsei University College of Mediicne from Jan. 1971 to Dec. 1980 were analyzed both clinically and radiologically and the following results were obtained. 1. Among the 27 patients, the ratio of boys and girls was 2:1 and the highest incidence was between the ages of 3 and 5 years. 2. The main course of fractures was traffic accidents, 14 cases (51.9%) and the other causes were falling from a height (37.0%) and a few cases of a slip and a fall. 3. According to the classification of Delbet and Colonna, the cervico-trochanteric fracture (40.8%) was the commonest type and 13 cases (48.1%) were displaced fractures. 4. Common associated injuries were pelvic bone fractures, skull fractures, cerebral concussion and soft tissue injuries. 5. Fifteen cases (55.6%) were treated by conservative treatment and ten cases (37.0%) by closed reduction & internal fixation. 6. 23 of the 27 cases were followed for from 6 months to 10 years, average 19 months. The results were analyzed according to Ratliffs assessment and 14 cases (60.9%) showed good results. 7. Total cases with complications were 14 (60.9%), the commonest complication being coxa vara (40.8%) and the other main complications being premature epiphyseal closure (39.1%) and avascular necrosis (30.1%). 8. Secondary treatment was done in 6 cases and correction osteotomy was done in 4 cases which had showed a poor result. 9. Finally, factors affecting results were type of fracture, degree of displacement, maintenance of reduction, interval between injury and treatment, complications and patients age. 10. The authors recommend closed reduction and internal fixation with some threaded pins for all type II and type III fractures.