outcome of fracture neck femur in children: a long-term follow up

ABSTRACT

This is a long-term follow up study of forty nine children with fracture of the neck of the femur who were treated and followed up at Hadra University Hospital. The age of these children at the time of injury ranged from 3 to 17 years [average of 10.2 years]. The follow up period averaged 9.3 years [range 5 to 19 years]. There were 23 males and 26 females. Thirty eight fractures [77.5%] were caused by major violence. There was a single transepiphyseal fracture, 25 transcervical fractures, 21 basicervical fractures and 2 intertrochanteric fractures. Five fractures were undisplaced. According to the method of treatment, the cases were grouped into 4 categories; five patients [10.2%] were treated by immobilisation in a hip spica; skeletal traction was used for treating two patients [4.1%]; internal fixation was the line of treatment in 36 fractures [73.5%]; and subtro chant eric osteotomy was the line of treatment in 6 cases [12.2%]. The overall results were good in 46.9%, fair in 24.5% and poor in 28.6% of patients. Better results were obtained in undisplaced fractures and in those displaced fractures where early anatomical reduction could be achieved and maintained throughout the treatment. Furthermore, the quality of reduction appeared to influence the occurrence of delayed complications such as avascular necrosis and non-union. Many early and delayed complications were encountered and reported. Avascular necrosis occurred in 40.8%, coxa vara in 38.8%, non union in 38.8%, premature epiphyseal closure in 40.8%, shortening in 59.1%, arthritic changes in 36.7%, coxa valga in 10.2%, coxa magna in 2% and post operative infection in 24.4% of patients