Femoral Neck Fractures in Children and Their Treatment With Knowles Pins

Volume: 9 Number: 3 November 26, 1975
  • Fahri Seyhan
EN TR

Femoral Neck Fractures in Children and Their Treatment With Knowles Pins

Abstract

Femorol neck fractures in children are uncommon injuries and often associated with excessive incidence of complications, such as avascular necrosis, malunion in coxa vara, nonunion and disturbance in growth. During last 12 years 37 cases with this injury are treated at Orthopedics and Traumatology Clinic of İstanbul Faculty of Medicine. Approximate ratio of adults to children with this iniury is thirty to one. Types of fractures, methods of treatment, results and com;plications of these 37 cases are studied. Immobilisation in a plaster spica was applied to eleven cases and result was five coxa vara and there avascular necrosis, immobilisation in a plaster spica after percutaneous insertion of Kirshner wires was employed in seven cases. This treatment prevented coxa vara deformity three of them had avascular necrosis. Internal fixation with Smith-Petersen nail was applied to three cases. This nail caused distraction of the fragments and should not be used in children. Internal fixation with Knowles pins was applied personaly to thirteen cases. Plaster cast immobilisation was not used in fresh fracture cases. Infection developed in two of these cases, one of them resulted in nonunion and avascular necrosis. Other two cases had late avascutar necrosis. In other cases fractures healed in three months and neither of them developped coxa vara nor disturbance of growth. Internal fixation and bone grafting after Mc Murray or Pauwels type osteotomy was applied to old ununited fractures of the older children. The neck and shaft angle was restored and union was achieved in all three cases. After reviewing the results of our cases and the previous reports in the literature, it is conciuded that= only undisplaced cemcothrocanteric and interthrocanteric fractures can be treated by immobilisation in the plaster cast. Displaced cervicothrocanteric fractures and transcervical fractures should be treated by internal fixation, Smith-Petersen nail should not be used in children. Internal fixation with Knowles pins should be the treatment of choice.

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