Comparison of three internal fixation techniques for treating displaced femoral neck fractures in children / 中华创伤杂志

ABSTRACT

Objective To compare the clinical efficacy of three internal fixation techniques,namely K-wire,hollow screw and pediatric hip locking compression plate (LCP),for treating displaced femoral neck fractures in children.Methods The clinical data of 56 patients treated from January 2010 to August 2015 were retrospectively analyzed by case-control study.All the patients received open reduction after unsuccessful closed reduction.According to the methods of internal fixation,the patients were divided into K-wire group (18 cases),hollow screw group (21 cases) and LCP group (17 cases).Operation time,intraoperative blood loss,neck-shaft reduction,bone union time,and complications after surgery were recorded.Ratliff and Harris scores at final follow-up visit were evaluated.Results In K-wire group,hollow screw group and LCP group,the operation times were respective(74.2 ± 12.9) min,(90.2 ± 18.9) min and (125.1 ± 20.6) min,the intraoperative blood loss of the three groups were respective (27.3 ± 15.4) ml,(32.4 ± 18.7) ml and (57.7 ± 22.1) ml,and the neck shaft reduction of the three groups were respective (3.74 ± 0.80) °,(2.96 ± 0.74) ° and (1.22 ± 0.39) °.K-wire group were superior to other two groups in operation time and intraoperative blood loss,and PHP group were better than the other two groups in prevention of neck-shaft reduction(P ＜ 0.05).There was one case in K-wire group with bone nonunion combined with hip varus.In K-wire group,hollow screw group and LCP group,the avascular necrosis were 11％,14％ and 12％,respectively (P ＞ 0.05).There were no statistically significant differences in follow-up time,bone union time,and Ratliff as well as Harris scores among the three groups (P ＞ 0.05).The case of epiphyseal premature closure,iatrogenic injury of blood vessel and nerve as well as osteo-fascial compartment syndrome was not observed after surgery.None of the patients had epiphyseal close,neurovascular injury and osteofacial compartment syndrome.Conclusions All three internal fixation techniques can have good clinical results in children with displaced femoral neck fractures after unsuccessful closed reduction.K-wire has advantages of less blood loss,shorter operation time and easier handling.Hollow screw has no obvious advantages or disadvantages in intraoperative situation and postoperative complications.Pediatric hip LCP can reduce the loss of neck-shaft angle and decrease the occurrence of hip varus.