[Closed reduction and internal fixation of pediatric femoral neck fractures]. / Geschlossene Reposition und perkutane Osteosynthese der Schenkelhalsfraktur im Kindesalter.

OBJECTIVE: To achieve anatomical reduction and stable fixation. Preservation of the proximal femoral physis is in this regard secondary. INDICATIONS: Nondisplaced and displaced femoral neck fractures Delbet types II and III. Incomplete fractures are debatable. No age restrictions. CONTRAINDICATIONS: Any patient condition that does not allow for general or regional anesthesia. Pathologic fractures requiring primarily an open approach. SURGICAL TECHNIQUE: Anatomical reduction is achieved via axial tension, internal rotation and gentle abduction or flexion of the affected hip and verified under image intensification; several stab incisions or a small single incision (3 cm) laterally at the level of the lesser trochanter to determine the entry points for the K­wires or screws; inserting and positioning the K­wires either as a configuration of two or three; depending on the bony dimensions fixation of the fracture with the K­wires or replacing them with cannulated screws; the localization of the main fracture line (basicervical or subcapital) determines whether the implants should cross the physis. POSTOPERATIVE MANAGEMENT: Partial weight bearing/touch ground (about 20% of bodyweight) for 6 weeks; either by using crutches or via mobilization in buggy or wheelchair. RESULTS: As an example, we present a case of a 9-year-old girl suffering from a displaced femoral neck fracture (Delbet type II) on the left side, who underwent closed reduction and internal screw fixation. Fracture healing and follow-up until today were uneventful. A brief review of the published literature is also provided.