Does the timing of treatment affect complications of pediatric femoral neck fractures?
Introduction
Fracture neck of femur in the pediatric population accounts for less than 1% of all fractures.1,2 Only a high-energy injury can produce enough force to break the pediatric femur neck. It is imperative to do early diagnosis and prompt treatment of pediatric femoral neck fracture to reduce complications, which include avascular necrosis (AVN), non-union, coxa-vara and premature physis closure.3
The initial impact force, the age of the patient, type of fracture, displacement at the fracture site, timing of surgery and treatment modality may play an important role in the outcome. The timing of surgery and the treatment modality are the only surgeon-dependent variable.4,5
Early reduction and stabilization of the fracture have shown lesser complications.4,6,7,8 Though, some authors believe that AVN is not influenced by the timing of surgery.9,10 It is not an uncommon scenario to have children with neck femur fracture presenting late. Aim of the study is to compare the union time and frequency of complications in children who presented early (less than 24 h) following injury with children who presented later (more than 24 h).
Section snippets
Materials and methods
A series of consecutive children from 2006 to 2016 presenting with femoral neck fractures in two tertiary-care centers were studied. Consents were taken for the participation in the study. All the children were less than 17 years.11 Their clinical and radiological details were retrieved from the medical records. We included the children with minimum 2-year follow-up period from the surgery. Children with polytrauma were included. Children with established non-union, pathological fractures and
Results
Thirty-two children (34 hips) were included in this study. The mean age of 15 children in group I and 17 children in group II were 10.44 ± 4.36 years and 12.83 ± 3.09 years respectively. Both the groups were comparable for the number of participants and age of the children. The time of union and complications are described in Table 3.
Conclusion
The frequency of the complications in pediatric neck femur fracture is comparable in early and late presented groups. The delayed union can be expected with late presented cases. Anatomical reduction and stabilization reduces the time of healing in fracture neck of femur in children. The frequency of AVN and other complications in femur neck fracture in children is independent of the timing of surgery. The complications may be related to the severity of the injury. The surgeon must consider an
Sources of funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author contribution
All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Kumar Amerendra Singh, Vidyasagar Chandankere and Hitesh Shah. The first draft of the manuscript was written by Kumar Amerendra Singh and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Declaration of competing interest
The authors declare that they have no conflict of interest.
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