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Complications of hip fractures in children
Feng-Chih Kuo1, Shu-Jui Kuo, Jih-Yang Ko
1Department of Orthopaedic Surgery Kaohsiung, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Insights
Pediatric hip fractures can lead to osteonecrosis, a severe complication impacting functional outcomes. Prompt surgery and quality reduction are key to preventing this in children with hip fractures.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
- Pediatric Bone Health
Background:
- Hip fractures are rare in children, typically resulting from high-energy trauma.
- The proximal femur's unique anatomy makes it vulnerable to injury and complications.
- Understanding complications like osteonecrosis is crucial for pediatric hip fracture management.
Purpose of the Study:
- To assess the impact of osteonecrosis on functional outcomes after pediatric hip fractures.
- To identify risk factors associated with the development of osteonecrosis in pediatric hip fractures.
Main Methods:
- Retrospective review of 23 pediatric hip fracture cases (1988-1997).
- Analysis of fracture types including transepiphyseal, transcervical, cervico-trochanteric, and intertrochanteric.
- Functional outcomes evaluated using Ratliff's criteria; risk factors for osteonecrosis analyzed.
Main Results:
- Osteonecrosis occurred in 48% of patients, significantly correlating with poor functional results.
- Premature physeal closure (48%) and other deformities were also observed.
- Surgical time (≤12 hours) and quality of reduction were significant predictors of osteonecrosis.
Conclusions:
- Osteonecrosis is the most severe complication of pediatric hip fractures, leading to poor functional outcomes.
- Timely surgical intervention and achieving a high-quality reduction are critical for mitigating osteonecrosis.
- These factors significantly influence the occurrence and severity of osteonecrosis, impacting long-term function.
Background:
Hip fractures account for < 1% of all pediatric fractures. Most are caused by a high-energy mechanism. Complications occur at a high rate because the vascular and osseous anatomy of the child's proximal femur is vulnerable to injury. The purposes of this study were to evaluate whether osteonecrosis influences the functional results and to analyze the risk factors for the development of osteonecrosis.
Methods:
We conducted a retrospective review of the complications of hip fractures (3 transepiphyseal fractures, 13 transcervical fractures, 6 cervico-trochanteric fractures, and 1 intertrochanteric fracture) in 23 patients (15 boys and 8 girls) between January 1988 and December 1997. Most injuries were caused by falling from a height or a motorcycle accident. The medical records and serial radiographs of all patients were reviewed. The function of the injured site was evaluated using Ratliff's criteria.
Results:
The ages of these children at the time of injury ranged from 1.5 to 16 years (average 11.1 years). The mean follow-up was 4.91 years (range, 1 year to 12 years and 7 months). Overall, complications included osteonecrosis in 11 (48%) patients, premature physeal closure in 11 (48%), coxa vara in 3 (13%) and coxa valga in 2 (9%). There was no nonunion. Poor outcomes were related to the development of osteonecrosis. The time to surgery (≤ 12 hours) and the quality of reduction significantly influenced the occurrence of osteonecrosis. The occurrence and severity of femoral head osteonecrosis significantly influenced the functional results (p < 0.001, and p < 0.048, respectively).
Conclusion:
Osteonecrosis is the most severe complication after hip fractures in children and is associated with poor functional results. The time to surgery and the quality of reduction were the significant predictors in our study.
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