title: CORRELATION BETWEEN AVASCULAR NECROSIS AND EARLY STABILIZATION OF PROXIMAL FEMORAL FRACTURES IN CHILDHOOD.
abstract: OBJECTIVE
  We developed this study with the aim of evaluating the results from treating patients with proximal femoral fractures, in a series of cases. We sought to observe the influence of the most prevalent complications on the final results after a minimum follow-up of two years. We especially considered the relationship between establishment of avascular necrosis and the time between the accident and the therapeutic intervention.
  
  
  METHODS
  We retrospectively studied proximal extremity fractures of the femur in 29 patients under 14 years of age between 1988 and 2007. We analyzed the following variables: sex, age, mechanism of injury, fracture classification (Delbet), treatment administered, complications (pseudarthrosis, varus deformity, leg length discrepancy and avascular necrosis), duration of surgery and results (Ratliff). We carried out individual descriptive analysis on each variable. The tests were used in accordance with the premise that normality applied. For the evaluation, we used Fisher's exact test.
  
  
  RESULTS
  Five patients (17.2%) had avascular necrosis, and three of them (60.0%) were over 10 years of age. 73.3% of the patients treated within the first 24 hours showed good results. The most common cause of fractures was traffic accidents (44.8%). The best results were observed among patients who were treated surgically. 41.4% developed some type of complication.
  
  
  CONCLUSIONS
  Among the 29 patients treated, 58.6% had good, 27.6% had regular and 13.8% had poor results, according to the Ratliff criteria. When conservative treatment was applied, only 17.0% had good results, while 69.3% had good results from surgical intervention. Likewise, 73.3% of the results were good results when surgery was performed within the first 24 hours and only 42.8% of the results were good among patients who underwent surgery after this period. Patients operated within the first 24 hours developed necrosis of the femoral head in 13.3% of cases, while 21.4% of those operated after this period developed this complication.
authors.affiliation: Resident Physician in the Department of Orthopedics and Traumatology, Paulista School of Medicine, Federal University of Sao Paulo, Sao Paulo, SP.
authors.forename: Diego da Costa
authors.initials: Dda C
authors.lastname: Astur
authors.affiliation: Resident Physician in the Department of Orthopedics and Traumatology, Paulista School of Medicine, Federal University of Sao Paulo, Sao Paulo, SP.
authors.forename: Gustavo Gonçalves
authors.initials: GG
authors.lastname: Arliani
authors.affiliation: Undergraduate Medical Student at the Paulista School of Medicine, Federal University of Sao Paulo, Sao Paulo, SP.
authors.forename: Carolina Lins E Silva
authors.initials: CL
authors.lastname: Nascimento
authors.affiliation: Orthopedist in the Department of Orthopedics and Traumatology, Paulista School of Medicine, Federal University of Sao Paulo, Sao Paulo, SP.
authors.forename: Francesco Camara
authors.initials: FC
authors.lastname: Blumetti
authors.affiliation: Orthopedist in the Department of Orthopedics and Traumatology, Paulista School of Medicine, Federal University of Sao Paulo, Sao Paulo, SP.
authors.forename: Marcio José Alher
authors.initials: MJ
authors.lastname: Fonseca
authors.affiliation: PhD in Medicine. Head of Clinical Medicine in the Discipline of Pediatric Orthopedics, Department of Orthopedics and Traumatology, Federal University of Sao Paulo, Sao Paulo, SP.
authors.forename: Eiffel Tsuyoshi
authors.initials: ET
authors.lastname: Dobashi
authors.affiliation: Adjunct Professor and Head of the Discipline of Pediatric Orthopedics, Department of Orthopedics and Traumatology, Federal University of Sao Paulo, Sao Paulo, SP.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Pinto
authors.affiliation: Titular Professor Titular and Head of the Department of Orthopedics and Traumatology, Federal University of Sao Paulo, Sao Paulo, SP.
authors.forename: Akira
authors.initials: A
authors.lastname: Ishida
keywords: Child; Femoral fractures/epidemiology; Femoral fractures/surgery