title: Fractures of the head and neck of the femur in children: an outcome study.
abstract: Fractures of the head and neck of the femur in children are very rare, occurring only after a high-velocity trauma, e.g. a fall from a height. This analysis shows the clinical course of traumatic femoral head and neck fractures in paediatric patients. Predisposing factors for poor outcome or fracture complications, such as non-union or femoral head necrosis, are described. Between 1993 and 2006, 16 paediatric patients with proximal femoral fractures were treated at the Level One Trauma Centre of the Medical University of Vienna. The minimum follow-up was two years. Inclusion criteria were age less then 16 years, intact growth plate and a proximal femoral fracture according to the classification by Delbet and Colonna. Exclusion criteria were pathological fractures or fractures of the subtrochanteric region (6/16). Ten patients met the inclusion criteria. Two patients were lost to follow-up. Therefore eight patients were included in the study. All patients except one were operated upon within 48 h after the injury ("primary") and healed without further complications. A single case was managed by "secondary" surgical treatment, two weeks after the initial trauma resulting in femoral head necrosis that healed without any subjective complaints. This case series confirms the importance of early surgical fixation of proximal femoral fractures in paediatric patients. An operative intervention later then 48 h after the initial trauma may increase the risk of complications such as femoral head necrosis, particularly in Delbet type I fractures (traumatic slipped capital femoral epiphysis).
authors.affiliation: Department of Trauma Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. s.hajdu@aon.at
authors.forename: Stefan
authors.initials: S
authors.lastname: Hajdu
authors.forename: Gerhard
authors.initials: G
authors.lastname: Oberleitner
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Schwendenwein
authors.forename: Helmut
authors.initials: H
authors.lastname: Ringl
authors.forename: Vilmos
authors.initials: V
authors.lastname: Vécsei
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D005270:Femur Head / Q000293:injuries*; D005271:Femur Head Necrosis / Q000209:etiology / Q000601:surgery; D017102:Fracture Healing; D006620:Hip Fractures / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D013997:Time Factors; D016896:Treatment Outcome