Femoral neck fractures in pediatric patients - 30 years experience at a level 1 trauma center

Femoral neck fractures in children are severe injuries associated with the potentially disastrous complication of femoral head osseous necrosis. Our primary goal was to identify what factors contribute to the occurrence of femoral head osteonecrosis in skeletally immature patients with femoral neck fractures. We evaluated a large consecutive series of pediatric patients with femoral neck fractures. Between 1970 and 2000, 20 patients with a mean age of 11 years (range, 4-15 years) with femoral neck fractures were identified. All traumatic epiphyseal, transcervical, and basicervical (Types I, II, and III) fractures were included. There were 14 male patients and six female patients. The mean followup was 7 years (range, 1-28 years). Timing of surgery, type of fixation, and quality of reduction were analyzed with respect to the primary outcome measure-radiographic evidence of femoral head osteonecrosis. Eighteen of 20 hip fractures healed without complication; all had good or excellent reductions. Two patients had osteonecrosis develop; both had fair or poor reductions. Five patients were treated more than 48 hours after injury, including the two patients who had osteonecrosis develop. The mean time to fixation for the remaining patients was 12 hours. There was no relationship between capsular decompression and osteonecrosis development. Quality of reduction and timing of reduction influenced the risk of osteonecrosis.