title: Femoral neck fractures in children and the role of early hip decompression in final outcome.
abstract: BACKGROUND
  Femoral neck fractures in children are very rare and account for about 1% of all paediatric fractures. The aim of this retrospective study was to analyse the clinical and radiographic outcome in paediatric femoral neck fracture and to review the role of early decompression of the hip in the final outcome.
  
  
  METHODS
  The study was performed at the Department of Paediatric Orthopaedics and Traumatology, University Children's Hospital in Belgrade, Serbia from January 1996 to January 2010. The study included 28 patients, 12 female and 16 male, aged 4-14 years. Patients who were aged over 14 years or who had pathological femoral neck fractures or metabolic disturbances were excluded from the study. The type of neck fracture was determined according to the Delbet and Colonna classification. The patients were treated using different surgical procedures: closed reduction and cast immobilisation, closed reduction and percutaneous fixation with Kirschner wires (K-wires), closed reduction and fixation with cannulated screws and open reduction with Wagner plate stabilisation. The final outcome was evaluated using the clinical outcome (based on the Howorth-Ferguson scale), radiographic outcome and occurrence of complications.
  
  
  RESULTS
  The median age of patients included in the study was 10.75 years and the average follow up was 9 years. According to the Delbet classification, there was one patient with type I, eight patients with type II, 16 patients with type III and three patients with type IV femoral neck fracture. Based on the Colonna classification, there were 23 displaced and five non-displaced femoral neck fractures. Decompression of the hip was performed in 21 patients. Avascular necrosis (AVN) developed as the main complication in 11 patients. The final outcome was excellent in 14 patients, good in four patients and poor in 14 patients.
  
  
  CONCLUSIONS
  Our study unequivocally confirms the positive effect of urgent treatment on the incidence of AVN as well as on the outcome. We have established a 12-hour interval after injury as an optimal time limit for commencing treatment. Unambiguously positive effects of hip decompression on the incidence of AVN were also noted. We found similar efficiency for open and needle hip decompression.
authors.affiliation: Department of Paediatric Orthopaedic Surgery, University Children's Hospital, Belgrade, Serbia. Electronic address: bojanbukva@yahoo.com.
authors.forename: Bojan
authors.initials: B
authors.lastname: Bukva
authors.affiliation: Department of Paediatric Orthopaedic Surgery, University Children's Hospital, Belgrade, Serbia.
authors.forename: Dušan
authors.initials: D
authors.lastname: Abramović
authors.affiliation: Department of Orthopaedic Surgery, University Hospital "Sveti Duh", Zagreb, Croatia.
authors.forename: Goran
authors.initials: G
authors.lastname: Vrgoč
authors.affiliation: Department of Surgery, University Hospital Rijeka, Rijeka, Croatia.
authors.forename: Marin
authors.initials: M
authors.lastname: Marinović
authors.affiliation: Department of Surgery, General Hospital Karlovac, Karlovac, Croatia.
authors.forename: Bore
authors.initials: B
authors.lastname: Bakota
authors.affiliation: Department of Paediatric Orthopaedic Surgery, University Children's Hospital, Belgrade, Serbia.
authors.forename: Siniša
authors.initials: S
authors.lastname: Dučić
authors.affiliation: Department of Orthopaedic Surgery, University Hospital "Sveti Duh", Zagreb, Croatia.
authors.forename: Mladen
authors.initials: M
authors.lastname: Miškulin
authors.affiliation: Department of Paediatric Orthopaedic Surgery, University Children's Hospital, Belgrade, Serbia.
authors.forename: Radivoj
authors.initials: R
authors.lastname: Brdar
authors.affiliation: Institute for Anthropological Research, Zagreb, Croatia.
authors.forename: Miran
authors.initials: M
authors.lastname: Čoklo
authors.affiliation: Clinic for Orthopaedic Surgery "Lovran", School of Medicine, University of Rijeka, Rijeka, Croatia.
authors.forename: Gordan
authors.initials: G
authors.lastname: Gulan
mesh_terms: D000293:Adolescent; D001863:Bone Screws; D001864:Bone Wires; D002648:Child; D002675:Child, Preschool; D019299:Decompression, Surgical / Q000379:methods*; D042241:Early Diagnosis; D005260:Female; D005265:Femoral Neck Fractures / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005271:Femur Head Necrosis / Q000175:diagnosis* / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D055771:Serbia / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Avascular necrosis; Children; Femoral neck fracture; Hip decompression