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- 저자 : Uttam Saini (검색결과 1 건)
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Pediatric Femoral Neck Fractures: Our 10 Years of Experience
Kamal Bali,Pebam Sudesh,Sandeep Patel,Vishal Kumar,Uttam Saini,M. S. Dhillon 대한정형외과학회 2011 Clinics in Orthopedic Surgery Vol.3 No.4
Background: Femoral neck fractures are rare injuries in children, but the high incidence of long term complications make it animportant clinical entity. The aim of this retrospective study was to analyze the clinical outcomes of pediatric femur neck fracturesthat we managed over a 10 year period. Methods: The study included 36 children (20 boys and 16 girls) who sustained femoral neck fractures and completed a minimumfollow-up of one year. The children were treated either conservatively, or by open reduction and internal fi xation (ORIF), or closedreduction and internal fi xation (CRIF). The outcomes were analyzed using Ratliff criteria and a detailed record of complicationswas kept for all patients. Results: The mean age of included patients was 10 years (range, 3 to 16 years) and the average follow-up was 3.2 years (range,1.1 to 8.5 years). Based on Delbet’s classifi cation system, there were 0 type I (transepiphyseal), 16 type II, 11 type III, and 9 type IVfractures. There were 8 undisplaced fractures, 4 of which later displaced after being managed initially in a hip spica. A satisfactoryoutcome was obtained in 27 (75%) children. Avascular necrosis (AVN) was the most common complication. It was seen in7 of our patients, all of whom had an unsatisfactory outcome. Other complications included three cases each of coxa vara, nonunion,and arthritic changes; and one case each of infection, primary screw perforation of head, and premature epiphyseal closure. Complications were lowest in the group treated by ORIF. Only 2 patients managed exclusively by conservative treatment ultimatelyachieved a satisfactory outcome. Conclusions: We believe that internal fi xation of pediatric femoral neck fractures is preferred whenever feasible because conservativetreatment carries a high risk of failure of reduction. Aggressive operative treatments aimed at anatomical reduction shouldbe the goal and there should be no hesitation in choosing ORIF over CRIF. Outcome of patients is infl uenced primarily by developmentof AVN which occurs as an independent entity without much relation to the mode of treatment carried out.
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