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Review Article Pediatric Femoral Neck Fracture
Joo Hyung Han, Hoon Park
Journal of Musculoskeletal Trauma 2021;34(1):34-43.
DOI: https://doi.org/10.12671/jkfs.2021.34.1.34
Published online: January 31, 2021
Department of Orthopaedic Surgery, Gangnam Severance Hospital, Seoul, Korea

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Abstract

Pediatric femoral neck fracture is an uncommon injury with a high complication rate, regardless of the appropriate diagnosis and management. The bony anatomy and blood supply of the proximal femur in a skeletally immature patient differ from those in adult patients. Generally, these fractures result from high-energy trauma, but pathologic hip fractures also occur, usually from low-energy trauma. Pediatric femoral neck fractures are categorized using the Delbet classification system. This classification guides management and aids clinicians in determining the risk of avascular osteonecrosis. The ideal surgical treatment is determined by the fracture type and the age of the patient. Reduction, which is achieved using a closed or open procedure, combined with stable fixation and/or cast immobilization, is recommended for most of these fractures. Anatomical reduction within 24 hours from the injury may result in a good surgical outcome. Although the effects of capsular decompression after reduction and fixation have not been established, decompression is easy to perform and may reduce the risk of avascular necrosis. Despite appropriate management, osteonecrosis can occur after all types of pediatric femur neck fractures. Other complications include coxa vara, nonunion, and premature physeal arrest.


J Korean Fract Soc. 2021 Jan;34(1):34-43. Korean.
Published online Jan 25, 2021.
https://doi.org/10.12671/jkfs.2021.34.1.34
Copyright © 2021 The Korean Fracture Society. All rights reserved.
Review

Pediatric Femoral Neck Fracture

Joo Hyung Han, M.D. and Hoon Park, M.D., Ph.D.
    • Department of Orthopaedic Surgery, Gangnam Severance Hospital, Seoul, Korea.
  • Correspondence to: Hoon Park, M.D., Ph.D. Department of Orthopaedic Surgery, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea. Tel: +82-2-2019-3418, Fax: +82-2-573-5393, Email: hoondeng@gmail.com
Received December 11, 2020; Revised December 17, 2020; Accepted December 17, 2020.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Pediatric femoral neck fracture is an uncommon injury with a high complication rate, regardless of the appropriate diagnosis and management. The bony anatomy and blood supply of the proximal femur in a skeletally immature patient differ from those in adult patients. Generally, these fractures result from high-energy trauma, but pathologic hip fractures also occur, usually from low-energy trauma. Pediatric femoral neck fractures are categorized using the Delbet classification system. This classification guides management and aids clinicians in determining the risk of avascular osteonecrosis. The ideal surgical treatment is determined by the fracture type and the age of the patient. Reduction, which is achieved using a closed or open procedure, combined with stable fixation and/or cast immobilization, is recommended for most of these fractures. Anatomical reduction within 24 hours from the injury may result in a good surgical outcome. Although the effects of capsular decompression after reduction and fixation have not been established, decompression is easy to perform and may reduce the risk of avascular necrosis. Despite appropriate management, osteonecrosis can occur after all types of pediatric femur neck fractures. Other complications include coxa vara, nonunion, and premature physeal arrest.

Keywords
Femoral neck fractures, Fracture fixation, Avascular osteonecrosis

Figures

Fig. 1
Delbet classification of pediatric femur neck fractures. (A) Type I, transepiphyseal fracture. (B) Type II, transcervical fracture. (C) Type III, cervicotrochanteric fracture. (D) Type IV, intertrochanteric fracture.

Fig. 2
(A) Anteroposterior radiograph of the 12-year-old boy who sustained a Delbet II femoral neck fracture. (B) Axial radiograph. (C) Radiograph after closed reduction and internal fixation with three cannulated screws inserted through physis. (D) Radiograph at one year after surgery showing union without complication.

Fig. 3
Ratliff classification of avascular necrosis after femur neck fracture. (A) Type I, involvement of the whole head. (B) Type II, partial involvement of head. (C) Type III, area of necrosis in the femoral neck from fracture line to physis.

Fig. 4
(A) Anteroposterior radiograph of the 11-year-old girl who developed avascular necrosis after a femur neck fracture. (B) Vagus osteotomy and internal fixation with plate were performed. (C) Five years postoperative radiographs that demonstrate partial remodeling of the femoral head.

Notes

Financial support:None.

Conflict of interests:None.

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    Pediatric Femoral Neck Fracture
    J Korean Fract Soc. 2021;34(1):34-43.   Published online January 31, 2021
    DOI: https://doi.org/10.12671/jkfs.2021.34.1.34
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