Short-term Results of the Treatment of Hip Fractures in Children

Abstract

Introduction Pediatric hip fractures are infrequent, associated with high-energy trauma, and present devastating complications. Most cases are treated surgically using different types of fixation. The objective of the present study is to report the results of a series of cases of surgical patients in two reference hospitals in Chile.

Materials and Methods A case series which included pediatric patients diagnosed with hip fractures and treated surgically between 2004 and 2008. We performed descriptive statistics for the demographic variables, the energy of the accident, the Delbet classification, the type of treatment, the osteosynthesis technique, of complications, and the clinico-radiological evaluation according to evaluation.

Results A total of 17 cases were evaluated, 76.5% of which were secondary to high-energy accidents. The median age of the sample was of 7 years, and it was composed of 58.8% of girls. There were 3 cases of Delbet type II, 9 of type III, and 5 of type IV. As fixation method, we used cannulated screws (9 cases), locking compression plates (LCPs; 5 cases), dynamic hip screws (DHSs; 2 cases), and dynamic compression plates (DCPs; 1 case). The median follow-up was of 2.3 years (range: 0.5 to 12.8 years). Complications were observed: coxa vara in one case, and discrepancy in the length of the lower extremities in another case, and there were no cases of osteonecrosis. Osteosynthesis removal was performed in seven patients. Good results were obtained in all patients according to Ratliff criteria.

Conclusions Most fractures were associated with high energy trauma, with the most frequent being type III on the Delbet classification. All the patients were treated surgically, with good results, with no cases of osteonecrosis.

Level of evidence: 4.

Keywords

hip fractures - osteosynthesis - children

Publication History

Received: 09 June 2021

Accepted: 10 January 2022

Article published online:
28 December 2022

• Referencias

• 1 Hajdu S, Oberleitner G, Schwendenwein E, Ringl H, Vécsei V. Fractures of the head and neck of the femur in children: an outcome study. Int Orthop 2011; 35 (06) 883-888
• 2 Green NE, Swiontkowski MF. Skeletal Trauma in Children E-Book. Elsevier Health Sciences; 2008
• 3 Mirdad T. Fractures of the neck of femur in children: an experience at the Aseer Central Hospital, Abha, Saudi Arabia. Injury 2002; 33 (09) 823-827
• 4 Bali K, Sudesh P, Patel S, Kumar V, Saini U, Dhillon MS. Pediatric femoral neck fractures: our 10 years of experience. Clin Orthop Surg 2011; 3 (04) 302-308
• 5 Yeranosian M, Horneff JG, Baldwin K, Hosalkar HS. Factors affecting the outcome of fractures of the femoral neck in children and adolescents: a systematic review. Bone Joint J 2013; 95-B [phone]
• 6 Ogden JA. Changing patterns of proximal femoral vascularity. J Bone Joint Surg Am 1974; 56 (05) 941-950
• 7 Trueta J. The normal vascular anatomy of the human femoral head during growth. J Bone Joint Surg Br 1957; 39-B [phone]
• 8 Davison BL, Weinstein SL. Hip fractures in children: a long-term follow-up study. J Pediatr Orthop 1992; 12 (03) 355-358
• 9 Canale ST, Bourland WL. Fracture of the neck and intertrochanteric region of the femur in children. J Bone Joint Surg Am 1977; 59 (04) 431-443
• 10 Flynn JM, Wong KL, Yeh GL, Meyer JS, Davidson RS. Displaced fractures of the hip in children. Management by early operation and immobilisation in a hip spica cast. J Bone Joint Surg Br 2002; 84 (01) 108-112
• 11 Song KS, Kim YS, Sohn SW, Ogden JA. Arthrotomy and open reduction of the displaced fracture of the femoral neck in children. J Pediatr Orthop B 2001; 10 (03) 205-210
• 12 Cheng JC, Tang N. Decompression and stable internal fixation of femoral neck fractures in children can affect the outcome. J Pediatr Orthop 1999; 19 (03) 338-343
• 13 Shrader MW, Jacofsky DJ, Stans AA, Shaughnessy WJ, Haidukewych GJ. Femoral neck fractures in pediatric patients: 30 years experience at a level 1 trauma center. Clin Orthop Relat Res 2007; 454 (454) 169-173
• 14 Colonna P. Fractures of the neck of the femur in children. Am J Surg 1929; 6: 793-797
• 15 Ratliff AH. Fractures of the neck of the femur in children. Orthop Clin North Am 1974; 5 (04) 903-924
• 16 Observatorio de Seguridad Vial [Internet]. Comisión Nacional de Seguridad de Tránsito.; 2020 . Disponible en: https://www.conaset.cl/programa/observatorio-datos-estadistica/
• 17 Gautier E, Ganz K, Krügel N, Gill T, Ganz R. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br 2000; 82 (05) 679-683