FRACTURE TYPE PRIMARILY INFLUENCES THE FINAL OUTCOME IN PEDIATRIC HIP FRACTURES

Abstract

The aim of this retrospective study was to assess the effects of several preoperative and intraoperative factors on the final clinical and radiological outcomes in pediatric hip fractures.

Forty-four pediatric patients with a hip fracture were treated at our department between January 1998 and September 2007. Thirty-nine patients with a minimum follow-up period of 1 year were included the study. Three patients had inadequate follow-up and two died at the early postoperative period. Mean age of 39 patients were 11.1 (4–16) years. There were 22 boys and 17 girls. The two main etiologic factors were traffic accident and fall from height. Associated injury was present in 15 patients and the pelvis and distal radius fractures were the two most common. The type of the hip fracture according to the Delbet classification was type II in 21, type III in 14 and type IV in 4 patients. Two patients were treated by a hip spica under general anesthesia and 37 were surgically treated by internal fixation using mostly 3 cancellous screws. Ratliff’s clinical and radiological assessment system was used to assess the final outcome and Ratliff’s classification was used for grading the avascular necrosis of the femoral head (AVN). The effects of patient age, gender, fracture type, fracture displacement, laterality, intervention time and capsulotomy on the final outcome were evaluated and a P value less than 0.05 was considered significant.

Mean follow-up was 3.1 (1–9.5) years and the final outcome was satisfactory (good) in 28 (72%) and unsatisfactory (fair or poor) in 11 (28%) patients. AVN was observed in 11 (28%) patients. No significant correlation was found between the final outcome and age (< =10 yrs vs. > 10 yrs; P=0.288), laterality (P=0.477), gender (P=0.158), intervention time (< =24 hours vs. > 24 hours; P=1.0), capsulotomy (P=0.609) or amount of displacement (displaced vs. non-displaced; P=0.078). However, there was a significant correlation between the final outcome and fracture type (worst in type II; P=0.014).

The risk of AVN is nearly 30% in pediatric hip fractures and it is the main determinant of the final outcome. The final radiological and clinical outcomes are correlated significantly with fracture type. Besides, fracture displacement may influence the final outcome. As, cervical femoral neck fractures (mainly displaced) have a higher risk of unsatisfactory outcome in children, the patients and parents should initially be warned about this subject.