[Anterolateral approach to femoral neck fractures in children]

Anatomic reduction and stable fixation of pediatric femoral neck fractures.

All unstable and displaced femoral neck fractures (AO classification 31-E/1.1, 31-E/1.2, 31-M/2.1 I-III, 31-M/3.1 I-III, 31-M/3.2 II-III).

Relative: Stable and nondisplaced femoral neck fractures.

The anterolateral approach uses the muscle interval between the gluteus medius and minimus muscles and the tensor fascia lata. It provides access to the anterior part of the hip joint for open reduction and allows the retention and osteosynthesis from the lateral aspect of the femur. By incision of the anterior capsule the blood supply of the femoral head is preserved and the fracture can be visualized. An anatomic reduction should be achieved and a stable osteosynthesis according to the age of child and fracture type and location should be performed.

After stable fixation additional immobilization is not required. Young children are mobilized in a wheel chair with no weight bearing; older children are mobilized with partial weight bearing with crutches. According to the age of the child and fracture type full weight bearing can be allowed after 4-8 weeks after radiographic follow-up.

Fractures of the femoral neck in children are rare and often associated with high-energy traumata. Complication rates are high such as avascular necrosis (AVN) of the femoral head, premature epiphyseal closure, nonunion, secondary displacement, coxa vara or infection. Different factors influence the outcome, including initial displacement, fracture classification, timing of reduction, stability of fixation or quality of reduction. However, especially in the lateral fractures the femoral head necrosis can be avoided by protecting the vascular supply. The reader of the article should be enabled to reduce the rate of AVNs by knowledge of the controllable risk factors and no longer accept AVN as predestined. There is a controversial discussion on the benefit of hematoma evacuation of the hip joint capsule and its influence on the rate of femoral head necrosis.