title: Treatment analysis of paediatric femoral neck fractures: a prospective multicenter theraupetic study in Indian scenario.
abstract: OBJECTIVE
  Paediatric femur neck fractures are exceedingly rare owing to dense bone surrounded by a strong periosteum; they account for 1 % of paediatric fractures and are usually associated with high energy trauma.
  
  
  METHODS
  This was a prospective multicenter therapeutic study on pediatric femoral neck fractures from June 2004 to September 2013 at three centres in Odisha, India. Children with femoral neck fractures (Delbet type 2 and 3) who were operated and completed a minimum one-year follow-up were included. We divided the neck of femur (100 %) into four zones (25 % each), with zone I being highly unstable and zone IV being most stable. Implants for fixation, as suggested by pre-operative zone distribution, were used.
  
  
  RESULTS
  Twenty-eight children were studied with mean two- to seven-year follow-up. In 23 children cancellous screws were used. In zone I Smooth Moore's pins that crossed the epiphysis were the implant of choice. Causes were avascular necrosis (14.2 %), nonunion (7.14 %) and one case of implant failure, while coxa vara was encountered in two instances. Functional results (Ratliff's criteria) were good in 82.1 %, fair in 7.1 % and poor in 10.7 % of patients; the mean IOWA hip scores were 96, 94 and 98, respectively.
  
  
  CONCLUSIONS
  Early surgical intervention hastens recovery, rehabilitation and return to school and decreases the risk of developing avascular necrosis. We suggest Smooth Pins fixation in zones I and II (nearer to zone I) and cancellous screw fixation in zones II, III and IV. Decompression of hip joint by capsulotomy releases the tamponade effect and should be performed in all cases of paediatric femoral neck fractures.
authors: Department of Orthopaedics, Hi-Tech Medical College & Odisha, Flat No.12, Block-I, Hi-Tech Medical College Campus, Health Park, Pandara, Bhubaneswar, 751025, India, ranajitpanigrahi@gmail.com.
authors: Ranajit
authors: R
authors: Panigrahi
authors: Biswajit
authors: B
authors: Sahu
authors: Amita Kumari
authors: AK
authors: Mahapatra
authors: Nishit
authors: N
authors: Palo
authors: Ashok
authors: A
authors: Priyadarshi
authors: Manas Ranjan
authors: MR
authors: Biswal
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019299:Decompression, Surgical; D005260:Female; D005265:Femoral Neck Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005271:Femur Head Necrosis / Q000145:classification / Q000517:prevention & control; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D007194:India; D057913:Joint Capsule Release; D008297:Male; D011446:Prospective Studies; D011859:Radiography; D016896:Treatment Outcome
references: Orthop Clin North Am. 1990 Apr;21(2):341-52
references: 2183134
references: Indian J Orthop. 2009 Jul;43(3):253-8
references: 19838347
references: Injury. 1994 Oct;25(8):493-6
references: 7960063
references: J Bone Joint Surg Am. 1994 Feb;76(2):283-92
references: 8113267
references: J Pediatr Orthop B. 2001 Jul;10(3):205-10
references: 11497363
references: J Bone Joint Surg Br. 1957 May;39-B(2):358-94
references: 13438980
references: Injury. 1996 Jul;27(6):419-21
references: 8881139
references: JAMA. 1961 Nov 25;178:799-801
references: 13904100
references: Injury. 2002 Nov;33(9):823-7
references: 12379394
references: J Bone Joint Surg Am. 1977 Jun;59(4):431-43
references: 863935
references: Clin Orthop Surg. 2011 Dec;3(4):302-8
references: 22162793
references: J Orthop Trauma. 2007 Apr;21(4):237-43
references: 17414550
references: J Bone Joint Surg Br. 2002 Jan;84(1):108-12
references: 11837814
references: J Pediatr Orthop. 1999 May-Jun;19(3):338-43
references: 10344316
references: J Bone Joint Surg Am. 1953 Oct;35-A(4):867-87
references: 13108889
references: J Orthop Trauma. 1992;6(3):306-13
references: 1403249
references: J Trauma. 1986 Apr;26(4):384-8
references: 3959144
references: J Pediatr Orthop. 1992 May-Jun;12 (3):355-8
references: 1573001
references: J Bone Joint Surg Am. 1971 Sep;53(6):1165-79
references: 4937290
references: J Bone Joint Surg Br. 1962 Aug;44-B:528-42
references: 14038616
references: J Orthop Trauma. 2006 May;20(5):323-9
references: 16766935
references: J Bone Joint Surg Br. 2010 Aug;92 (8):1148-51
references: 20675763
references: Clin Orthop Relat Res. 2005 Mar;(432):87-96
references: 15738808
references: Acta Orthop Scand. 1980 Feb;51(1):91-108
references: 7376851
references: Injury. 2005 Jan;36(1):123-30
references: 15589930
references: Clin Orthop Relat Res. 1986 May;(206):117-26
references: 3708964