Functional and radiological results of the surgical treatment of pediatric femoral neck fractures

Year 2022, , 21 - 26, 27.03.2022

Duran Topak , Mustafa Abdullah Özdemir , Fatih Doğar , Ökkeş Bilal

https://doi.org/10.30565/medalanya.1025510

Abstract

Aim: Our aim in this study was to evaluate the demographic data on femoral neck fractures, postoperative complications, and functional and radiological results following its surgical treatment in the pediatric age group. Pediatric femoral neck fractures often occur after high-energy trauma and seen rarely.

Methods: Twenty-six patients who underwent surgery after the diagnosis of femoral neck fracture in our clinic between 2012 and 2019 were examined. Demographic data, trauma mechanism, accompanying injuries, and postoperative complications of the patients were recorded from our registry system. Functional radiological evaluation was performed using Ratliff criteria.

Results: The mean age of the participants in the study was 11.11 (3–16) year, and the mean follow-up time was 29.34 (12-60) months. According to Ratliff criteria, 18 patients (69.2%) achieved good, 6 patients achieved (23.1%) moderate, and 2 patients achieved (7.7%) poor results after surgery. Avascular necrosis was observed in 5 patients (19.2%) in total. Avascular necrosis did not occur in 10 patients who underwent surgery within first 6 hours. Avascular necrosis occurred in 5 (31.25%) out of 11 patients who underwent surgery after 6 hours. This result was statistically significant (p = 0.049). Of the 5 patients with avascular necrosis, 3 were female and 2 were male. The clinical and radiological results were evaluated according to the Ratliff criteria, and the results were found to be worse in females than in men. There was a statistically significant difference between the genders (p=0.029).

Conclusion: Although femoral neck fractures are rare injuries in the pediatric age group, they are important due to the high risk of complications. The most important complication is avascular necrosis. Results are better males than in females. The results of surgical treatments aimed at anatomical reduction in the shortest possible time are satisfactory.

Keywords

pediatric, avascular necrosis, Delbert classification, Femoral neck fracture

Pediatrik femur boyun kırıklarının cerrahi tedavisinin fonksiyonel ve radyolojik sonuçları

Abstract

Amaç: Bu çalışmamızda pediatrik yaş grubunda femur boyun kırığı nedeniyle opere edilen hastaların demografik verilerini, komplikasyonlarını ve tedavi sonuçlarını değerlendirmeyi amaçladık.

Yöntem: 2012-2019 yılları arasında kliniğimizde femur boyun kırığı tanısı ile opere edilen 26 hasta incelendi. Kayıt sistemimizden hastaların demografik bulguları, travma mekanizması, eşlik eden yaralanmaları ve ameliyat sonrası gelişen komplikasyonları kaydedildi. Hastalarda fonksiyonel radyolojik değerlendirme Ratliff kriterleri kullanılarak yapıldı.

Bulgular: Çalışmaya katılanların yaş ortalaması 11,11 ( 3-16) yıl, ortalama takip süresi 29,34 (12-60) aydı. Hastaların %65,4’ ü erkek (n=17), %34,6 ‘sı (n=9) kadın hastaydı. Delbert sınıflama sistemine göre ameliyat öncesi 14 hasta tip 2, 12 hasta tip 3 kırıktı. Ameliyat sonrası Ratliff skorlama sistemine göre 18 hasta (%69,2) iyi, 6 hasta (%23,1) orta, 2 hasta (%7,7) kötü sonuç olarak değerlendirildi.

Toplamda 5 hasta da (%19,2) avasküler nekroz görüldü. Bu 5 hastanın 2’ si delberte göre tip 2, 3 tanesi delbert tip 3 kırıktı. İlk 6 saat içinde ameliyat edilen 10 hastada avasküler nekroz görülmedi. 6. Saatten sonra opere edilen 11 hastadan 5’inde (%31,25) avasküler nekroz gözlendi. İki grup arasında istatiksel olarak anlamlı fark saptandı (p=0,049). Avasküler nekroz görülen 5 hastanın 3’ü kız, 2’si erkek idi. Ratlife göre kadın hastaların 7’sinde iyi-orta sonuç, 2’sinde kötü sonuç saptandı. Erkek hastaların tamamında iyi-orta sonuç görülürken kötü sonuç saptanmadı. Klinik ve radyolojik sonuçlar Ratliff kriterlerine göre değerlendirildi ve sonuçların kadınlarda erkeklere göre daha kötü olduğu görüldü. Cinsiyetler arasında istatistiksel olarak anlamlı bir fark vardı (p=0.029).

Sonuç: Pediatrik yaş grubunda femur boyun kırıkları nadir görülen yaralanmalar olsa da yüksek komplikasyon riski sebebiyle önem taşır. En önemli komplikasyon avasküler nekrozdur. Sonuçlar erkeklerde kadınlara göre daha iyidir. Mümkün olan en kısa sürede anatomik redüksiyonu amaçlayan cerrahi tedavinin sonuçları tatmin edicidir.

Keywords

çocuk, avasküler nekroz, Delbert sınıflaması, Femur boyun kırığı

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