Fractures of the Femoral Neck in Children / 대한정형외과학회잡지

ABSTRACT

Fractures of the femoral neck in children are rare and usually severe violence to occur, which accounts for the high frequency of associated injuries. Since the femoral neck in children has many anatomic and physiologic differences, not only are there many difficulties during the treatment period, but complications such as post-traumatic coxa vara, avascular necrosis of the femoral head, and premature epiphyseal closure may occur, sixty-two cases in sixty patients of fractures of the femoral neck in children which were treated at Severance Hospital, Yonsei University College of Medicine from Jan. 1971 to Dec. 1987 and at Young-Dong severance Hospital, Yonsei University college of Medicine from May. 1983 to Dec. 1987 were analyzed both clinically and radiologically. The following results were obtained l. Of the 62 cases, the ratio of boys to girls was approximately 21 and the highest incidence was between 4 to 6 years old. 2. The main cause of fracture was traffic accidents, which occurred in 33 cases(53.2%). 3. According to the classification of Delbet and Colonna, the cervicotrochanteric fracture was the most common type(41.9% of the cases) and 29 cases(46.8%) were displaced fractures. 4. Thirty two cases(51.6%) were treated by conservative treatment and twenty eight cases (45.2%) by closed reduction and internal fixation. 5. Common associated injuries were genito-urinary tract injury, soft tissue injury, long bone fracture and pevic bone fractures. 6. All cases were followed for from 14 months to 15 years, average 8 years. 7. The results were analyzed according to Ratliff's assessment and 41 cases(66.1%) showed good results. 8. The total number of cases with complications was 33(53.2%). The most common complication being coxa vara and premature epiphyseal closure(32.2%). 9. Secondary treatment was done in 7 cases and correction osteotomy was done in 4 cases which had showed a good results. The authors found that for the treatment of type IV fractures, closed reduction followed by plaster of Paris immobilization was adeguate but for type I, II, III after early closed reduction, internal fixation was performed as soon as possible using threaded pins as the internal fixation device. The results were poor in type I and type II, fractures with severe displacement, and in cases in which the treatment was delayed due to associated injury.