Three-Year Experience and Outcomes of Near-Early Internal Fixation for Femoral Neck Fractures in Pediatric Trauma Patients: A Retrospective Study

Abstract

Background The fractured neck of the femur in children is commonly caused by high-energy trauma, and despite its low incidence, complications are more frequent. Delayed presentation is not unusual in developing countries. The interval between injury and surgery is thought to be a critical factor in determining outcomes. This study aims to evaluate the effectiveness of "near early" internal fixation (24-72 hours) for fractured neck of the femur in children. Methods This is a retrospective observational study that analyzed complete case records from a period of seven years. Cases were classified according to the Delbet classification and outcomes were assessed using the Ratliff criteria with a minimum follow-up of three years. Results The study included 24 male and 11 female patients, with an average age of 11.28 years. The most common cause of injury was road traffic accidents. The fracture distribution in the study population was as follows: Delbet type II in 18 patients, Delbet type III in 10 patients, and Delbet type IV in seven patients. In our study, all patients underwent near-early fixation, meaning their fractures were fixed within 24-72 hours of injury. The average time for the clinical-radiological union was 8 weeks, and the most common complication was premature physeal fusion, followed by osteonecrosis. Conclusion In developing countries, where patients often experience delayed referrals and lack of awareness, near-early fixation (24-72 hours) of a fractured neck of the femur in children is a crucial option that holds significant value.

Keywords: delbet classification; fracture neck of femur; near early fixation; osteonecrosis of femoral head; paediatric fracture.

Figure 1. Eight-year-old female patient had a history of road traffic accident; (a) anteroposterior and lateral views showing Delbet type II fracture; (b) anteroposterior and lateral views showing good outcome at the follow-up.

Figure 2. A thirteen-year-old female patient got injured in a road traffic accident. (a) The anteroposterior and lateral views show the Delbet type II fracture; (b) at 1 year of follow-up, she developed osteonecrosis (Ratliff type II) and had a fair outcome.

Figure 3. A twelve-year-old male had a road traffic accident. The (a) anteroposterior and lateral views show the Delbet type II fracture fixed with cannulated cancellous screw (b) and at the 1.5 years of follow-up, he developed osteonecrosis (Ratliff type I) and had poor outcome.

Figure 4. Fifteen-year-old boy had (Delbet type III) fracture due to a fall from height as shown in (a) anteroposterior and lateral views, managed by CRIF with cancellous screws. At the earliest follow-up visit, he revealed the history of early weight bearing. The patient was advised not to bear weight till further order. At eight months of follow-up, (b) anteroposterior view shows the superior screw cut-out and the patient presented with a pus-discharging sinus.

CRIF: closed reduction and internal fixation.