Displaced femoral neck fractures in children: are complications predictable?

Abstract

Introduction: Serious complications can occur in the management of displaced femoral neck fractures in children. Are there ways to anticipate this risk and better define eventual contributing factors?

Patients and methods: Twenty-one children (14 boys and 7 girls) were treated between 1999 and 2006 for displaced femoral neck fractures. Nine type II, 10 type III and two type IV fractures were observed according to the Delbet's classification. Anatomical open reduction was performed in 13 patients and closed reduction in eight patients. At a mean follow-up of 26.4 months, the outcome was assessed according to the Ratliff criteria. Postoperative complications were analysed according to the age, fracture type, time-to-surgery and open or closed reduction.

Results: The mean age was 12.1 years. The final outcome was defined as good in 14 patients(66.66%), fair in one patient (4.76%) and poor in six patients (28.58%). Complications occurred in seven patients (33.33%), avascular necrosis (AVN) of the femoral head being the most frequent one (28.58%). In all cases, necrosis was observed in children older than 12 years (p < 0.05) and when time-to-surgery exceeded 48 h (p < 0.05). Necrosis occurred in 44.44% of type II fractures and in 20% of type III fractures (p > 0.05). Only one materialised after closed reduction (p < 0.05).

Discussion: Various factors may contribute to the development of complications in children with femoral neck fractures. Our study supports the hypothesis that older age, late surgery and open reduction are definite predictors of avascular necrosis occurrence.

Level of evidence: Retrospective study, level IV.