[Femoral neck fractures in childhood]. / Schenkelhalsfrakturen im Kindesalter.

In a retrospective multicenter study we followed-up 30 fractures of the neck of the femur in children aged 11 years (1.5-15 years) for 4.8 years (0.5-20.0 years). It is the aim of this study to analyse factors possibly related to outcome, like age at injury, type of fracture, interval between injury and treatment, method of stabilization and postoperative interval until full weight bearing. At follow-up subjective parameters (pain, weather sensitiveness), clinical parameters (range of motion, claudication, leg length discrepancies) and radiological parameters (hip series) were investigated and medical charts and roentgenograms were reviewed using a standardized protocol. 29 of 30 children (96.7%) have sustained displaced fractures. Non-operative treatment has been applied in 4 children. 26 femoral neck fractures (type I: 1, type II: 8, type III: 17) were stabilized by internal fixation using screws and/or pins. Following non-operative treatment one child suffered a coxa vara and another child suffered a avascular femoral head necrosis in combination with coxa vara and leg length shortening of 4 cm. Following operative treatment 9 of 26 children (34.6%) suffered a avascular femoral head necrosis and 3 children (11.5%) suffered a coxa vara. In 6 of 26 children (23%) we observed leg length discrepancies > 2 cm. We were not able to demonstrate any significant follow-up result differencies between the groups of children who have sustained type II or type III fractures, or between the groups of children aged < 10 years when compared to children aged > 10 years, or between the group of children who were operated on within 6 hours after the accident when compared to the group of children operated > 6 hours after the accident. We observed no significant follow-up result differences between the groups of children who had different intervals between operation and full weight bearing. Operative fracture management remains the treatment of choice in the majority of displaced femoral neck fractures in children. However, in our limited study we were not able to demonstrate any significant follow-up result differences between the group of children treated by immediate open reduction and internal fixation (interval injury - operation < 6 hours) when compared to children who had been operated > 6 hours after the injury.

[Use of a dynamic balance for standardized imaging technique in entire roentgen images of the spine of children in the upright position]. / Einsatz einer dynamischen Wippe zur standardisierten Aufnahmetechnik von Röntgengesamtaufnahmen der Wirbelsäule im Stehen bei Kindern.

INTRODUCTION: Malposture can simulate deformities of the spine in non-standardized X-rays of the spine. MATERIALS AND METHODS: A balancelike positioning device was developed in order to avoid "pseudodeformities" because of the patient's malposture while an X-ray of the spine was being taken. A comparative pilot study (100 patients) was performed and about 3,000 X-rays of the spine were taken routinely using the positioning device. RESULTS: The clinical examination and radiological findings did not agree, a second X-ray was taken using the balancelike positioning device. One-third of those patients had much better findings with the balance, one-third slightly better results, and one-third revealed no significant improvement of the malposture in the X-ray film compared with the initial X-ray without the balance device. DISCUSSION: Comparable X-rays of the spine can only be taken if posture during the procedure is defined and reproducible. "Casual" posture and "standardized" posture differed in more than two-thirds of our comparative pilot study (n = 100). The findings with a balance device were never inferior compared to the X-rays taken without it. CONCLUSION: A simple balancelike positioning device can help to standardize X-rays of the spine when the patient is standing, providing better reproducibility, more accurate prognostic aspects and fewer ionizing hazards.