Femoral N eek Fractures in Children

Sixteen cases of femoral neck fractures were treated at Shaikh Zayed Hospital during the last three years from 1986 to 1989 and results of treatment were reviewed in 15 cases. Patients were categorized in two main groups, those with fresh fractures (6) and those who presented late (10); either with varus deformity of the femoral neck (5) or with established nonunion (5). Using Ratliffsf4] criteria results were 100% excellent or good in fresh fractures and ununited fractures with varus deformity and 80% good results in established nonunion. No complications were observed in patients wi.tb. lt:esh. hac.tu,es bu\. c.<.\u.,�\,c:<1..\.\C'I\\. -.:u.\.1!.. ,�u."' \\,�\.\. '""' fractures with varus deformity and those with nonunion. Shortening of the affected extremity from 1-3 cm was found in 100% of these fractures. Fracture neck femur in children is a rare injury [1,2]. The rarity of this fracture is indicated by the scanty literature with few case reports on the subject. The initial case reports in the English literature were those of Barber in 1871, Crowcl in 1885, apμ Whitmann in 1891 as cited by Tachdjianf2]. In 1951 Jngram and Bachynski studied 24 cases treated since 1930 by surgeons of the Campbell clinic in Memphis[3J. They noted that fracture neck of femur' in children resulted from severe trauma and avasculfir necrosis was a serious complication. They advocated the treatment of the fracture with internal fixation of the fragments. Ratliff in 1962 reported a large series of 71 cases and later in 1981 he added 97 cases, a total of 168 cases and found avascular necrosis to be the most common complication[4,5]. Complications were most commonly found in displaced fractures (69%) than with fractures having no initial displacement (33%)[5). Lam presented a personal series of 92 cases of femoral neck fracture in children and noted that displaced transcervical and cervieotrochanteric fractures remained an unsolved problemf 6]. He found coxa vara the most common complication (32%) followed by avascular necrosis (17%) in patients seen early. Leung and Lam reviewed these 92 children 111 1986 both clinically and radiologically, at 13-23 years after injury[7]. Early results had been excellent in these patients but later review showed an 83% incidence of radiographic abnormality and 24% had pain, limp or leg shortening. Purpose of this study is to evaluate the results of treatment of femoral neck fractures at Shaikh Zayed Hospital Lahore during the last three years.