Complications associated with surgically treated hip fractures in children

Although hip fractures make up less than 1% of all children's fractures, they commonly produce late complications such as avascular necrosis, non-union, coxa vara, and premature physeal closure. A retrospective review of 17 patients with a mean age of 11 years (range, 7-14) and with a mean follow-up of 6 years (range, 2.5-12) who underwent open reduction and internal fixation for hip fractures was performed. There were 10 transcervical and five cervicotrochanteric fractures, one transepiphyseal fracture, and one intertrochanteric fracture. A total of 25 operations were performed. Overall, the complication rate was 59%, with some patients having more than one complication. Seven patients healed without any complications or sequelae. In the remaining 10 patients, the complications were avascular necrosis (nine patients), coxa vara (eight patients), premature physeal closure (seven patients), non-union (four patients), and chondrolysis (one patient). Avascular necrosis, non-union, and chondrolysis were associated with a poor outcome. At final follow-up, the results were assessed using Ratliff's criteria and included seven patients with good, six with fair, and four with poor outcome.