Abstract
Introduction
Paediatric hip fracture accounts for less than one percent of paediatric fractures. Previous studies report complication rates between 20 and 92%.
Method
We retrospectively identified patients with fixation for neck of femur fractures at Birmingham Children's Hospital. All patients were under age sixteen. Data were reviewed over a 10 year period (1997-2006). Fractures were classified by Delbet's classification and Ratliff's system to grade avascular necrosis (AVN). Function was assessed using Ratcliff's criteria, incorporating clinical examination and radiographic findings.
Results
15 femoral neck fractures were treated in 14 patients over a ten year period (R=1997-2006). One patient sustained bilateral fractures. Three patients had osteogenesis imperfecta and one osteopetrosis. Mean age at injury was 10.3 years (R=6-14 years). Mean follow-up was 31 months (R=6-110 months). Two fractures were Delbet type-I (13.3%), four type-II (26.7%), six type-III (40%) and three type-IV fractures (20%).
Associated injuries included calcaneal fracture, head injury, pubic rami, acetabular and tibial fractures, hip dislocation, and depressed skull fracture with extradural haematoma. Eleven patients were operated on within 24 hours (R=4-19 hours) and four after 24 hours (R=2-11 days). One patient operated on within seven hours had a poor outcome.
Premature physeal closure (PPC) occurred in all patients with physeal penetration (Fishers Exact test: p=0.077). The results were ‘good’ in 14 patients (93%) and ‘poor’ in one patient with Ratliff's Type I avascular necrosis (6.7%). This 13 year old male sustained a Delbet type 1 fracture with dislocation of the femoral epiphysis after a road traffic accident. The AVN and PPC rates were 6.7% and 33%. Coxa vara was diagnosed in two patients. One patient developed a significant leg length discrepancy (>2cm). Superficial wound infections occurred in two patients. No non-unions occurred.
Conclusion
Complication rates are lower than historical studies.
