Elsevier

Injury

Volume 33, Issue 9, November 2002, Pages 823-827
Injury

Fractures of the neck of femur in children: an experience at the Aseer Central Hospital, Abha, Saudi Arabia

https://doi.org/10.1016/S0020-1383(02)00013-XGet rights and content

Abstract

The Orthopaedics Unit of Aseer Central Hospital, Abha, Saudi Arabia became fully operational in 1992. From then till 1999, 14 cases of fractures of the neck of femur in children under the age of 16 years were studied. The aims of the study were to compare our experience with those of other institutions and to serve as a reference point in this region for future study of this rare but disabling condition.

The case notes of all the patients aged less than 16 years with fractures of the neck of femur managed at the Aseer Central Hospital between 1992 and 1999 were analysed retrospectively. Information obtained included age, sex, type of fracture, management, outcomes and complications. There were 14 children. The age range between 4 and 16 years (mean = 9.1 ± 3.8 years). Male to female ratio was 1:1.3. Eight cases (57.1%) were due to road traffic crashes and 6 (42.9%) were due to falls from height. Six cases (42.9%) were of Delbet type II (transcervical) fractures, 5 cases (35.7%) were of type III (cervicotrochanteric), and 3 cases (21.4%) were of type IV (intertrochanteric) fractures. There was no case of Delbet type I (transepiphyseal separation). Patients were treated either surgically by reduction and internal fixation or conservatively by traction followed by hip spica cast application. Avascular necrosis occurred in 7 cases (50.0%). Only 3 cases of partial avascular necrosis were seen and all the 3 improved. The rest 4 (28.6%) had collapse of the femoral head. In only 2 cases (14.3%) of femoral neck fracture, the patients did not have any associated injuries. While fracture of neck of the femur is rare in children, the high incidence of complications that can lead to life-long disability makes it an important clinical entity.

Introduction

Fracture of the neck of femur in normal children is rare but is known to be associated with a high rate of complications, especially femoral head necrosis [1], [2], [3]. When it occurs, it is usually due to severe high-velocity trauma [3], or a pathological process affecting the bone [1], [4], [5], [6], [7]. Hamilton [8] believes that most orthopaedic surgeons will see only a few of this type of fracture in children in their entire professional career. Various reports confirm the rarity of this condition [9], [10], [11]. Cheng and Tang [9] in a retrospective study over a 10-year period reported only 14 cases of fractures of the neck of femur in patients under 16 years of age. Sferopoulos and Papavasiliou [10] reported 20 cases of intracapsular fractures of the femur in children below 14 years of age. In a retrospective study between 1926 and 1988 from the University of Iowa, Davison and Weinstein [11] reported 26 cases of hip fractures in children between the age of 1–16 years.

Many authors stress the fact that the importance of this condition is not because of the frequency of its occurrence but because of the frequency and life-long disability resulting from complications [2], [3], [4], [8], [11].

The aims of this report were to review all the cases of fractures of the neck of femur in children, seen at the Aseer Central Hospital, Abha since the establishment of the orthopaedic unit in 1992 until 1999 and to share our experiences in the management of this important condition and to provide a reference point for future study of this pathology in this region.

Section snippets

Patients and methods

Aseer Central Hospital is the tertiary referral centre for Aseer region of Saudi Arabia. Almost all the fractures of femoral neck in children are referred to Aseer Central Hospital for management. The Aseer region (population 1,200,000) is located in the southwest of Saudi Arabia covering an area of more than 80,000 km2. The region lies a few kilometres away from the northern border of the neighbouring Yemen [12].

This is a retrospective study of fractures of the neck of femur in children below

Results

Fourteen children presented with 14 femoral neck fractures over the 8-year period of the study. Femoral neck fractures constituted only 0.3% of all the fractures treated in children during this period and 0.6% of femoral neck and intertrochanteric fracture. Five femoral neck fractures (35.7%) occurred on the right side and nine (64.3%) on the left side. The mean age was 9.1±3.8 years (range 4–16 years). There were six males and eight females. (male:female ratio was 1:1.3). Eight cases (57.1%)

Management and outcomes

All six patients (42.9%) with Delbet type II fractures were treated by closed reduction and internal fixation (Fig. 1a and b). All of them developed avascular necrosis (AVN) of the femoral head (Fig. 2). In this group, three were of Ratliff type-I AVN [14] involving the whole femoral head with subsequent collapse of the head. The other three were Ratliff type-II AVN [14] involving only a part of the head of femur (Fig. 3). These three cases improved without collapse of the femoral head.

Of the

Discussion

Fractures of the neck of femur are rare [1], [2], [3], [4], [5], [6], [7], [8], [14]. They account for <1% of all paediatric fractures [14] and the prevalence is <1% of those seen in adults [1], [2], [3]. In this series, femoral neck fractures in children accounted for 0.3% of all pediatric fractures and 0.6% of those of adults, thus confirming the rarity of these fractures in general and in the Aseer region of Saudi Arabia in particular. The aetiological factors of femoral neck fracture in

Acknowledgements

To Professor Mohd. Yunus Khan MD, MNAMS of the Department of Family and Community Medicine, College of Medicine and Medical Sciences, Professors O. Osinowo and O. Ajao of the Department of Surgery, College of Medicine and Medical Sciences for their kind help in revising the manuscript.

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