Management of childhood femoral neck fractures

Area of Science:

• Orthopedic surgery
• Pediatric orthopedics
• Trauma surgery

Background:

• Displaced transcervical femoral fractures in children pose treatment challenges.
• Assessing long-term outcomes of surgical interventions is crucial for pediatric orthopedic care.

Purpose of the Study:

• To evaluate the effectiveness of internal fixation alone versus internal fixation with primary transverse intertrochanteric osteotomy for displaced transcervical femoral fractures in children.
• To compare functional outcomes and fracture union rates between the two treatment groups.

Main Methods:

• Retrospective review of 43 children with displaced transcervical femoral fractures.
• Patients were treated with either internal fixation alone (22 patients) or internal fixation with primary transverse intertrochanteric osteotomy (21 patients).
• Outcomes were assessed using Ratliff's criteria at a mean follow-up of 7.2 years.

Main Results:

• Internal fixation alone resulted in 10 good, 6 fair, and 6 poor outcomes.
• The addition of osteotomy yielded 14 good, 5 fair, and 2 poor outcomes, though not statistically significant (P=0.139).
• Osteotomy significantly improved fracture union rates, with no delayed union or non-union observed (P=0.05), and no osteotomy-related complications.

Conclusions:

• While functional outcomes did not reach statistical significance, the addition of primary transverse intertrochanteric osteotomy to internal fixation significantly enhances fracture union in pediatric transcervical femoral fractures.
• This combined approach appears safe, with no complications directly attributed to the osteotomy procedure itself.