A clinical Study of the Fractures of the Femoral Neck in Children

Kim, Ik Dong; Kim, Poong Taek; Park, Byung Chul; Choi, Young Wook; Lyu, Young Goo; Kyung, Hee Soo

Abstract

Fractures of the femoral neck in children are uncommon and usually occur as a result of severe trauma due to their anatomical and physiologic characteristics. There are many difficulties during the treatment period and high incidence of complications such as avascular necrosis, coxa vara and premature epiphyseal closure. Twenty-three cases of fractures of the femoral neck in children which were treated at Kyung-Pook National University Hospital from Aug., 1980 to May, 1989 were analyzed both clinically and radiologically. The results were as follws: l. Among the 23 cases, higher incidence was in girls(13 cases, 56.5%) and the highest incidence was between the age of 11 and 13 years(8 cases, 34.8%). 2. The main cause of fracture was traffic accident(16 cases, 69.6%). 3. The most common type of fracture was the transcervical type(9 cases, 39.1%) and 17 cases (73.9%) were displaced fractures. 4. Associated injuries occurred in 13 cases(56.5%), and the common associated injuries were extremity fractures, head injuries and pelvic bone fractures. 5. Minimally displaced 7 cases(30.4%) were treated by closed reduction & internal fixation, and neglected, irreducible 15 cases(65.2%) by open reduction & internal fixation and undisplaced intertrochanteric fracture(1 case) by closed reduction & hip spica cast. 6. Twenty-three cases were followed from 8 months to 9 years and average period of follow-up studies was 28 months. The results were good in 5 cases(71.4%), fair in 2 cases (28.6%) in closed reduction & internal fixation, and good in 9 cases(60%), fair in 2 case(13.3%), poor in 4 cases(26.7%) in open reduction & internal fixation. 7. Complications were developed in 11 cases(47.8%), and premature epiphyseal closure were in 7 cases(30.4%), and avascular necrosis were in 6 cases(26.1%), and coxa vara were in 3 cases (13%), and delayed union was in 1 case and infection was in 1 case. 8. As a result, we recommend early closed reduction & internal fixation as the favorable method of treatment for the fracture of the femoral neck in children better than open reduction & internal fixation or conservative methods.