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Management of femoral neck fractures in children

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Management of femoral neck fractures in children

  1. 1. FEMORAL NECK FRACTURES IN CHILDREN - REVIEW OF CASE SERIES ON FIVE PATIENTS MANAGED AT THE NATIONAL ORTHOPAEDIC HOSPITAL, DALA-KANO NOA CONFERENCE “IFE 2012”
  2. 2. AUTHORS: Isa N, Salihu MN, Alada AA, Alabi IA, Arinze A and Tella AO National Orthopaedic Hospital, Dala-Kano, Nigeria.
  3. 3. INTRODUCTION • Femoral neck fractures are rare conditions in children. • Most of the fractures result from high-energy trauma. • Complications are associated with serious long-term morbidities.
  4. 4. INTRODUCTION “ Hip fractures in children are of interest because of the frequency of complications rather than the frequency of fractures.”[1] - CANALE
  5. 5. AIMS/OBJECTIVES • The aim was to evaluate the pattern of presentation, clinical outcome and complications associated with the management of paediatric femoral neck fractures at NOH, Dala-Kano.
  6. 6. PATIENTS AND METHOD • The study reviewed the clinical records of paediatric patients presenting with femoral neck fractures or its complication managed at the NOH, Dala-Kano, between May 2008 and June 2012. • Inclusion criteria: - Age 16 years at the time of injury˂ - Complete radiographic records
  7. 7. PATIENTS AND METHOD • Eight patients were managed but only five met criteria for analysis . • Delbet classification was used. • All patients had operative treatment with either cannulated screws alone or primary osteotomy stabilized with paediatric osteotomy plate. • Ratliff criteria was used for outcome analysis in 4 of the 5 patients, who had completed 1 year follow-up.
  8. 8. A. Pre-op. B. 6-weeks post-op. C. Follow-up at 1 year
  9. 9. A. Pre-op B. Immediate post-op C. 3-month post-op
  10. 10. A. Pre-op B. 6 weeks post-op C. 1-year post-op.
  11. 11. RESULTS • Patient Demographics: Patient characteristics No of cases Remarks Gender -Male -Female 4 1 Age range (in years) 0-5 6-10 11-15 0 2 3 Laterality of Facture -Right -Left 0 5
  12. 12. RESULTS • Mechanism of injury: No of cases Remarks Fall from height - storey building - tree top 1 2 RTA - MV-pedestrian - Motorcycle 1 1
  13. 13. RESULTS • Associated injuries: No of cases Percentage Facial injury 1 Blunt chest injury 2 No assoc. injury 2
  14. 14. RESULTS Patient Duration of injury Mode of presentation Delbet type Treatment 1 10 days Painful limp II ORIF + Cannulated screws 2 3 weeks Painful limp, LLD III Osteotomy plate + screw 3 4 months Malunion, coxa vara, LLD III Osteotomy plate only 4 7 months Malunion, coxa vara, LLD III Osteotomy plate only 5 9 months Non-union, coxa vara, LLD II Osteotomy plate + Screw
  15. 15. RESULTS • OUTCOME OF TEATMENT: Patient Delbet type Complications Ratliff outcome 1 II - Good 2 III - - 3 III Surgical site infection Good 4 III Premature physeal closure (LLD-6cm) Fair 5 II Avascular necrosis Fair
  16. 16. DISCUSSION • Paediatric femoral neck fractures are uncommon. • The average incidence, worldwide is 1% of˂ all paediatric fractures [1,2,3,4,5]. - May be higher in our environment [6]. • Most cases result from high-energy trauma.
  17. 17. DISCUSSION • The presence of physis and vascular peculiarities make paediatric femoral neck fractures an important clinical entity. • The risk of severe complications like AVN and growth arrest, make prompt treatment of paediatric femoral neck fractures a priority.
  18. 18. DISCUSSION • Delbet classified these fractures into 4 types - Type I : Transepiphyseal (5-10%) - Type II : Transcervical (50%) - Type III : Cervico-trochanteric or Basal (35%) - Type IV : Intertrochanteric (10-15%) • Our study revealed more of type III (3 patients).
  19. 19. DISCUSSION • Three of our patients, presented late with complications – malunion, nonunion and coxa vara. • Initial TBS involvement in 3 patients - Remaining 2 cases were referrals • We offered 4 of our patients primary osteotomy due to the mode of presentation.
  20. 20. DISCUSSION • Of all the complications reported in the literature, AVN is the most common and most devastating [7,8]. • Quick et al [9], reported an average incidence of 6-53% for AVN in paediatric femoral neck fractures. • In our study, AVN occurred in 1 patient, and risk factors identified include: - Type of fracture and displacement - Late presentation.
  21. 21. DISCUSSION • A case of premature physeal closure occurred, with worsening LLD at follow-up. • Residual coxa vara also seen in 2 patients. • Other complication seen was surgical site infection in 1 patient.
  22. 22. DISCUSSION • Ratliff criteria:
  23. 23. CONCLUSION • The clinical outcome of our study was mainly influenced by late presentation. • Malunion, Nonunion and coxa vara were seen as primary complications rather than secondary. • Based on Ratliff criteria, at the end of 1 year, 2 of our patients had satisfactory outcome.
  24. 24. MANY THANKS
  25. 25. REFERENCES • 1) Canale ST, Bourland WL. Fracture of the neck and intertrochanteric region of the femur in children. J Bone Joint Surg Am. 1977 Jun.;59(4):431–443. • 2) Bali et al. Paediatric Femoral Neck Fractures. Clinics in Orthop. Surg. 2011; Vol.3 No. 4; 302-308. • 3) Arora et al. Outcomes in Paediatric Femoral Neck Fractures. Delhi J. of Orthop. 2004; 1: 25-49. • 4) Bimmel et al. Paediatric Hip Fractures: A systematic review of incidence, treatment options and complications. Acta Orthop. Belg. 2010; 76; 7-13. • 5) Feng-Chih Kuo et al. Complications of paediatric hip fractures. Cnang Gung Med J. 2011; Vol.34, No. 5
  26. 26. REFERENCES • 6) Nwadinigwe et al. Fractures in children. Nigerian J of medicine. Jan-Mar 2006; Vol. 15, No. 1, • 7) Ratliff. Fractures of the neck of the femur in children. J Bone Joint Surg Br. 1962;44-B:528–542. • 8) Pedro et al. Nonunion of fractures of the femoral neck in children. J Child Orthop. 2008; 2: 97-103 • 9) Quick TJ, Eastwood DM. Pediatric Fractures and Dislocations of the Hip and Pelvis. Clin Orthop Relat Res. 2005;432:87–96

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