Functional and radiological results of the surgical treatment of pediatric femoral neck fractures

Yıl 2022, Cilt: 6 Sayı: 1, 21 - 26, 27.03.2022

Duran Topak , Mustafa Abdullah Özdemir , Fatih Doğar , Ökkeş Bilal

https://doi.org/10.30565/medalanya.1025510

Öz

Aim: Our aim in this study was to evaluate the demographic data on femoral neck fractures, postoperative complications, and functional and radiological results following its surgical treatment in the pediatric age group. Pediatric femoral neck fractures often occur after high-energy trauma and seen rarely.

Methods: Twenty-six patients who underwent surgery after the diagnosis of femoral neck fracture in our clinic between 2012 and 2019 were examined. Demographic data, trauma mechanism, accompanying injuries, and postoperative complications of the patients were recorded from our registry system. Functional radiological evaluation was performed using Ratliff criteria.

Results: The mean age of the participants in the study was 11.11 (3–16) year, and the mean follow-up time was 29.34 (12-60) months. According to Ratliff criteria, 18 patients (69.2%) achieved good, 6 patients achieved (23.1%) moderate, and 2 patients achieved (7.7%) poor results after surgery. Avascular necrosis was observed in 5 patients (19.2%) in total. Avascular necrosis did not occur in 10 patients who underwent surgery within first 6 hours. Avascular necrosis occurred in 5 (31.25%) out of 11 patients who underwent surgery after 6 hours. This result was statistically significant (p = 0.049). Of the 5 patients with avascular necrosis, 3 were female and 2 were male. The clinical and radiological results were evaluated according to the Ratliff criteria, and the results were found to be worse in females than in men. There was a statistically significant difference between the genders (p=0.029).

Conclusion: Although femoral neck fractures are rare injuries in the pediatric age group, they are important due to the high risk of complications. The most important complication is avascular necrosis. Results are better males than in females. The results of surgical treatments aimed at anatomical reduction in the shortest possible time are satisfactory.

Anahtar Kelimeler

pediatric, avascular necrosis, Delbert classification, Femoral neck fracture

Pediatrik femur boyun kırıklarının cerrahi tedavisinin fonksiyonel ve radyolojik sonuçları

Öz

Amaç: Bu çalışmamızda pediatrik yaş grubunda femur boyun kırığı nedeniyle opere edilen hastaların demografik verilerini, komplikasyonlarını ve tedavi sonuçlarını değerlendirmeyi amaçladık.

Yöntem: 2012-2019 yılları arasında kliniğimizde femur boyun kırığı tanısı ile opere edilen 26 hasta incelendi. Kayıt sistemimizden hastaların demografik bulguları, travma mekanizması, eşlik eden yaralanmaları ve ameliyat sonrası gelişen komplikasyonları kaydedildi. Hastalarda fonksiyonel radyolojik değerlendirme Ratliff kriterleri kullanılarak yapıldı.

Bulgular: Çalışmaya katılanların yaş ortalaması 11,11 ( 3-16) yıl, ortalama takip süresi 29,34 (12-60) aydı. Hastaların %65,4’ ü erkek (n=17), %34,6 ‘sı (n=9) kadın hastaydı. Delbert sınıflama sistemine göre ameliyat öncesi 14 hasta tip 2, 12 hasta tip 3 kırıktı. Ameliyat sonrası Ratliff skorlama sistemine göre 18 hasta (%69,2) iyi, 6 hasta (%23,1) orta, 2 hasta (%7,7) kötü sonuç olarak değerlendirildi.

Toplamda 5 hasta da (%19,2) avasküler nekroz görüldü. Bu 5 hastanın 2’ si delberte göre tip 2, 3 tanesi delbert tip 3 kırıktı. İlk 6 saat içinde ameliyat edilen 10 hastada avasküler nekroz görülmedi. 6. Saatten sonra opere edilen 11 hastadan 5’inde (%31,25) avasküler nekroz gözlendi. İki grup arasında istatiksel olarak anlamlı fark saptandı (p=0,049). Avasküler nekroz görülen 5 hastanın 3’ü kız, 2’si erkek idi. Ratlife göre kadın hastaların 7’sinde iyi-orta sonuç, 2’sinde kötü sonuç saptandı. Erkek hastaların tamamında iyi-orta sonuç görülürken kötü sonuç saptanmadı. Klinik ve radyolojik sonuçlar Ratliff kriterlerine göre değerlendirildi ve sonuçların kadınlarda erkeklere göre daha kötü olduğu görüldü. Cinsiyetler arasında istatistiksel olarak anlamlı bir fark vardı (p=0.029).

Sonuç: Pediatrik yaş grubunda femur boyun kırıkları nadir görülen yaralanmalar olsa da yüksek komplikasyon riski sebebiyle önem taşır. En önemli komplikasyon avasküler nekrozdur. Sonuçlar erkeklerde kadınlara göre daha iyidir. Mümkün olan en kısa sürede anatomik redüksiyonu amaçlayan cerrahi tedavinin sonuçları tatmin edicidir.

Anahtar Kelimeler

çocuk, avasküler nekroz, Delbert sınıflaması, Femur boyun kırığı

Kaynakça

• 1. Song KS. Displaced fracture of the femoral neck in children: open versus closed reduction. J Bone Joint Surg Br. 2010 Aug;92(8):1148-51. doi: 10.1302/0301-620X.92B8.24482.
• 2. Davison BL, Weinstein SL. Hip fractures in children: a long-term follow-up study. J Pediatr Orthop. 1992 May-Jun;12(3):355-8. doi: 10.1097/01241398-199205000-00014.
• 3. Morsy HA. Complications of fracture of the neck of the femur in children. A long-term follow-up study. Injury. 2001 Jan;32(1):45-51. doi: 10.1016/s0020-1383(00)00109-1.
• 4. Günay H. Çocukluk çağı proksimal femur kırıkları ve travmatik kalça çıkıkları.TOTBİD dergisi. 2019;18:425-430. doi: 10.14292/totbid.dergisi.2019.54
• 5. Patterson JT, Tangtiphaiboontana J, Pandya NK. Management of Pediatric Femoral Neck Fracture. J Am Acad Orthop Surg. 2018 Jun 15;26(12):411-419. doi: 10.5435/JAAOS-D-16-00362.
• 6. Togrul E, Bayram H, Gulsen M, Kalaci A, Ozbarlas S. Fractures of the femoral neck in children: long-term follow-up in 62 hip fractures. Injury. 2005 Jan;36(1):123-30. doi: 10.1016/j.injury.2004.04.010.
• 7. Leung PC, Lam SF. Long-term follow-up of children with femoral neck fractures. J Bone Joint Surg Br. 1986 Aug;68(4):537-40. doi: 10.1302/0301-620X.68B4.3733826.
• 8. Mirdad T. Fractures of the neck of femur in children: an experience at the Aseer Central Hospital, Abha, Saudi Arabia. Injury. 2002 Nov;33(9):823-7. doi: 10.1016/s0020-1383(02)00013-x.
• 9. Canale ST, Bourland WL. Fracture of the neck and intertrochanteric region of the femur in children. J Bone Joint Surg Am. 1977 Jun;59(4):431-43. PMID: 863935.
• 10. Pavone V, Testa G, Riccioli M, Di Stefano A, Condorelli G, Sessa G. Surgical treatment with cannulated screws for pediatric femoral neck fractures: A case series. Injury. 2019 Jul;50 Suppl 2:S40-S44. doi: 10.1016/j.injury.2019.01.043.
• 11. Roposch A, Saraph V, Linhart WE. Treatment of femoral neck and trochanteric simple bone cysts. Arch Orthop Trauma Surg. 2004 Sep;124(7):437-42. doi: 10.1007/s00402-004-0702-5.
• 12. Bimmel R, Bakker A, Bosma B, Michielsen J. Paediatric hip fractures: a systematic review of incidence, treatment options and complications. Acta Orthop Belg. 2010 Feb;76(1):7-13. PMID: 20306957.
• 13. Moon ES, Mehlman CT. Risk factors for avascular necrosis after femoral neck fractures in children: 25 Cincinnati cases and meta-analysis of 360 cases. J Orthop Trauma. 2006 May;20(5):323-9. doi: 10.1097/00005131-200605000-00005.
• 14. Bali K, Sudesh P, Patel S, Kumar V, Saini U, Dhillon MS. Pediatric femoral neck fractures: our 10 years of experience. Clin Orthop Surg. 2011 Dec;3(4):302-8. doi: 10.4055/cios.2011.3.4.302.
• 15. Shrader MW, Jacofsky DJ, Stans AA, Shaughnessy WJ, Haidukewych GJ. Femoral neck fractures in pediatric patients: 30 years experience at a level 1 trauma center. Clin Orthop Relat Res. 2007 Jan;454:169-73. doi: 10.1097/01.blo.0000238794.82466.3d.
• 16. Lin ZH, Sun YF, Wu XS, Liu ZY, Yin SQ. [Comparison of the effect between early anatomical open reduction, internal fixation and closed reduction, internal fixation for treatment of children displaced femoral neck fracture]. Zhongguo Gu Shang. 2012 Jul;25(7):546-8. Chinese. PMID: 23115982.
• 17. Canale ST. Fractures of the hip in children and adolescents. Orthop Clin North Am. 1990 Apr;21(2):341-52. PMID: 2183134.
• 18. Dendane MA, Amrani A, El Alami ZF, El Medhi T, Gourinda H. Displaced femoral neck fractures in children: are complications predictable? Orthop Traumatol Surg Res. 2010 Apr;96(2):161-5. doi: 10.1016/j.rcot.2010.02.004.
• 19. Taylor KF, McHale KA. Percutaneous pin fixation of a femoral neck fracture complicated by deep infection in a 12-year-old boy. Am J Orthop (Belle Mead NJ). 2002 Jul;31(7):408-12. PMID: 12180627.
• 20. Pape HC, Krettek C, Friedrich A, Pohlemann T, Simon R, Tscherne H. Long-term outcome in children with fractures of the proximal femur after high-energy trauma. J Trauma. 1999 Jan;46(1):58-64. doi: 10.1097/00005373-199901000-00010.
• 21. Bagatur AE, Zorer G. Complications associated with surgically treated hip fractures in children. J Pediatr Orthop B. 2002 Jul;11(3):219-28. doi: 10.1097/00009957-200207000-00005.
• 22. Tetsunaga T, Akazawa H, Tetsunaga T. Intra-articular loose body caused by avascular necrosis of the femoral head in children. J Pediatr Orthop B. 2014 Jan;23(1):44-8. doi: 10.1097/01.bpb.0000434244.41569.6b.
• 23. Varshney MK, Kumar A, Khan SA, Rastogi S. Functional and radiological outcome after delayed fixation of femoral neck fractures in pediatric patients. J Orthop Traumatol. 2009 Dec;10(4):211-6. doi: 10.1007/s10195-009-0072-4.
• 24. Panigrahi R, Sahu B, Mahapatra AK, Palo N, Priyadarshi A, Biswal MR. Treatment analysis of paediatric femoral neck fractures: a prospective multicenter theraupetic study in Indian scenario. Int Orthop. 2015 Jun;39(6):1121-7. doi: 10.1007/s00264-015-2677-y.
• 25. Bombaci H, Centel T, Babay A, Türkmen IM. Femur boynu kiriği nedeniyle ilk 24 saatten sonra ameliyat edilen çocuklarda gelişen komplikasyonlarin değerlendirilmesi [Evaluation of complications of femoral neck fractures in children operated on at least 24 hours after initial trauma]. Acta Orthop Traumatol Turc. 2006;40(1):6-14. Turkish. PMID: 16648672.
• 26. Nayeemuddin M, Higgins GA, Bache E, O'hara J, Glitheroe P. Complication rate after operative treatment of paediatric femoral neck fractures. J Pediatr Orthop B. 2009 Nov;18(6):314-9. doi: 10.1097/BPB.0b013e32832d5d5f.
• 27. Inan U, Köse N, Omeroğlu H. Pediatric femur neck fractures: a retrospective analysis of 39 hips. J Child Orthop. 2009 Aug;3(4):259-64. doi: 10.1007/s11832-009-0180-y.