Open femoral neck fracture of 14 years old boy treated by                      emergency internal fixation with additional osteomuscular pedicle graft: case report

<p>The incidence of femoral neck fractures in pediatric patients is rare, including <1% in all cases of fractures in children. The mechanism of injury is a high-energy injury that can cause a fracture in the femoral neck, open fracture cases are rare. Avascular necrosis is the most common complication. We report a fourteen year old boy who was in a road-traffic accident and had a Gustillo Anderson grade IIIA open femoral neck fracture. On the X-ray findings, we classified the type of fracture into Delbet type II. We decided to do the debridement and ORIF accompanied by an osteomuscular pedicle graft using a quadratus femoris muscle tendon fixed with 3 interfragmentary screws. Short-term evaluation shows a clinical union picture and is still well reduced without any signs of infection. Long-term evaluation of the bone healing process is needed and recognizes complications in the form of avascular necrosis of the femoral head.</p>

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Pediatric Femoral Neck Fractures after Sliding in a Water Slide: A Case Report of Two Patients

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i05.2210 ◽

2021 ◽

Vol 11 (5) ◽

Author(s):

Barak Rinat ◽

Noam Bor ◽

Eytan Dujovny ◽

Nimrod Rozen ◽

Guy Rubin

Keyword(s):

Case Report ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Avascular Necrosis ◽

Treatment Options ◽

High Energy ◽

Neck Of Femur ◽

Neck Fracture ◽

Fracture Diagnosis ◽

Pediatric Orthopedic

Introduction: In contrast to adults, fractures of the neck of femur in children are relatively rare. The commonly described mechanism of injury is high energy trauma. Treatment options are almost always surgical. Prognosis, which entails relatively high rates of complications, varies with specific anatomic location, time to surgery, and reduction quality. Case Report: We describe two cases of 10- and 12-year-old girls who suffered a fracture of the neck of the femur, Delbet Type II and Type III, respectively, due to a suspected hyper-abduction injury while sliding on a water slide. Both patients were treated surgically, with the younger one developing signs of femoral head avascular necrosis a year postoperatively. Conclusion: Children with pain and an inability to bear weight after water sliding together with an adult companion at their backs should raise suspicion among medical staff of a femoral neck fracture. Prompt pediatric orthopedic consultation and treatment are needed in case of fracture diagnosis to reduce the risk of complications. Keywords: Avascular necrosis, child, femoral neck fracture.

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Treatment of the femoral neck peudoarthrosis in childhood: Case report

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1304237v ◽

2013 ◽

Vol 141 (3-4) ◽

pp. 237-241

Author(s):

Zoran Vukasinovic ◽

Igor Seslija ◽

Mladen Pavlovic ◽

Zorica Zivkovic

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Avascular Necrosis ◽

Bed Rest ◽

Primary Treatment ◽

Femoral Neck Fractures ◽

Coxa Vara ◽

X Ray ◽

Fractures In Children ◽

Neck Fracture

Introduction. Femoral neck fractures in children and adolescents are rare. However, their complications are frequent - avascular necrosis, femoral neck pseudoarthrosis, premature physeal closure with consequent growth disturbance and coxa vara deformity. Case Outline. A 9.5?year?old boy was injured in a car accident, and femoral neck fracture was diagnosed. Prior to admission at our hospital he was surgically treated several times. He was admitted at our hospital eight months following the accident. On the X?ray transcervical pseudoarthrosis of the femoral neck was found, as well as coxa vara deformity and metaphyseal avascular necrosis. He was operated at our hospital; all previously placed ostefixation material was removed, valgus osteotomy of 30 degrees was done as well as additional local osteoplasty using the commercial osteoindactive agent (Osteovit?). Postoperatively, we applied skin traction, bed rest and physical therapy. At the final follow?up, the patient was recovered completely. He is now painless, the legs are of equal length, range of movements in the left hip is full, life activity is normal. The X?ray shows that the femoral neck pseudoarthrosis is fully healed. Conclusion. This case is presented in order to encourage other colleagues to challenge the problematic situation such as this one. Also, we would like to remind them what one should think about and what should be taken into consideration in the primary treatment of femoral neck fractures in children. Valgus femoral osteotomy, as a part of the primary treatment of femoral neck fracture in children (identically as in the adults) can prevent the occurrence of femoral neck pseudoarthrosis.

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A systematic review of undisplaced femoral neck fracture treatments for patients over 65 years of age, with a focus on union rates and avascular necrosis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-017-0528-9 ◽

2017 ◽

Vol 12 (1) ◽

Cited By ~ 27

Author(s):

Dan-Feng Xu ◽

Fang-Gang Bi ◽

Chi-Yuan Ma ◽

Zheng-Fa Wen ◽

Xun-Zi Cai

Keyword(s):

Systematic Review ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Avascular Necrosis ◽

Neck Fracture

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Avascular necrosis after femoral neck fracture in children and adolescents: poor prognosis and risk factors

International Orthopaedics ◽

10.1007/s00264-021-05210-2 ◽

2021 ◽

Author(s):

Ziqi Li ◽

Zhikun Zhuang ◽

Zhinan Hong ◽

Leilei Chen ◽

Wei He ◽

...

Keyword(s):

Risk Factors ◽

Femoral Neck ◽

Children And Adolescents ◽

Femoral Neck Fracture ◽

Avascular Necrosis ◽

Poor Prognosis ◽

Neck Fracture

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Comminuted Femur Fracture in a Free Fall Jump: A Case Report

Military Medicine ◽

10.1093/milmed/usz417 ◽

2019 ◽

Vol 185 (7-8) ◽

pp. e1318-e1319

Author(s):

Rachel E Bridwell ◽

Joshua J Oliver ◽

Danielle Ziehl ◽

Lloyd I Tannenbaum ◽

Patrick M McCarthy

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Femur Fracture ◽

Free Fall ◽

High Energy ◽

Injury Patterns ◽

Cephalomedullary Nail ◽

Lower Altitude ◽

Special Operations ◽

Neck Fracture

Abstract Military free fall or high-altitude low-opening parachute jumps play a key role in special operations tactics, though injury patterns in these operators are not well characterized. In contrast to lower-altitude static line paratroopers, free fall operators require precise parachute deployment after a prolonged descent, with the potential for high-velocity trauma. This report describes a 33-year-old Marine Corps Reconnaissance operator who sustained left comminuted basicervical femoral neck fracture requiring cephalomedullary nail internal fixation with a full recovery. This femoral neck fracture highlights the high-energy injuries experienced by these invaluable operators, especially when conducting combat or night jumps.

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The clinical and radiographic characteristics of avascular necrosis after pediatric femoral neck fracture: a systematic review and retrospective study of 115 patients

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02037-2 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Pengfei Xin ◽

Yonggang Tu ◽

Zhinan Hong ◽

Fan Yang ◽

Fengxiang Pang ◽

...

Keyword(s):

Systematic Review ◽

Retrospective Study ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Avascular Necrosis ◽

Rapid Progression ◽

Femoral Head Collapse ◽

Neck Fracture ◽

Strong Relation ◽

The Mean

Abstract Background Avascular necrosis (AVN) after pediatric femoral neck fracture (PFNF) showed poor prognosis, but its clinical and radiographic characteristics remained unclear. Methods A systematic review and a retrospective study were performed to evaluate the clinical and radiographic characteristics of patients with AVN after PFNF. Results A total of 686 patients with PFNF and 203 patients with AVN from 21 articles were analyzed. Ratliff’s classification was used in 178 patients, with types I, II, and III AVN accounting for 58.4%, 25.3%, and 16.3%, respectively. Ratliff’s assessment was used in 147 patients, of whom 88.4% had an unsatisfactory prognosis. In retrospective study, 115 patients with a mean age of 13.6 ± 2.0 years were included. The mean interval between AVN and PFNF was 13.7 ± 9.5 months. At the time of diagnosis, 59.1% cases were symptomatic and 65.2% progressed to collapsed stage. Fifty (43.5%), 61 (53.0%), and 4 patients (3.5%) were defined as types I, II, and III , respectively, via Ratliff’s classification. Thirteen (11.3%), 40 (34.8%), and 62 patients (53.9%) showed types A/B, C1, and C2 disease, respectively, via the JIC classification. Multivariate analysis demonstrated a strong relation between collapsed stage and symptomatic cases (OR = 6.25, 95% CI = 2.39–16.36) and JIC classification (OR = 3.41, 95% CI = 1.62–7.17). Conclusion AVN after PFNF showed a tendency toward extensive necrotic lesions, presumably resulting in a rapid progression of femoral head collapse. And the symptoms and the JIC classification are other two risk factors of collapse progression.

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