Ahmet Issın, İsmet Yalkın Çamurcu, Mehmet Nuri KONYA, Vedat Şahin

Pediatrik Femur Boyun Kırıklarının Klinik ve Radyolojik Sonuçları

Amaç: Bu çalışmanın amacı, pediatrik femur boyun kırıklarının klinik ve radyolojik sonuçlarını değerlendirmek ve sonuçları literatürle karşılaştırmaktır.Yöntemler: 2005-2012 tarihleri arasında femur boyun kırıklıkları tanısıyla tedavi edilen hastaları retrospektif olarak taradık. Takiplerini aksatmayan ve minimum 1 yıllık takip süresi olan 14 hasta (6 kız çocuk, 8 erkek çocuk) kayıtlardan bulundu. Kırığın nedeni ve uygulanan tedavi tipi kayıtlardan araştırıldı. Kırık tipini belirlemede Delbet-Colonna sınıflaması kullanıldı. Son kontrolde, femur boyun-şaft açısı ve etkilenen kalçanın hareket açıklığı ölçüldü. Nihai sonuç Ratliff’in değerlendirme kriterlerine göre skorlandı. Avasküler nekrozlar (AVN) Ratliff’in AVN sınıflama sistemine göre sınıflandırıldı.Bulgular: Hastaların ortalama yaşı 9.9 olup ortalama takip 35 aydı. Delbet-Colonna sınıflamasına göre; hastalardan 1’i tip 1 (%7.1), 4’ü tip 2 (%28.6), 8’i tip 3 (%57.2) ve 1’i tip 4’dü (%7.1). 14 kırığın 8’i kaymış kırıktı (%57.2) ve 6’sı kaymamış kırıktı (%48.2). Ratliff değerlendirme kriterlerine göre, 14 hastanın 11’inin iyi (%78.6), 1’inin orta (%7.1) ve 2’sinin (%14.3) kötü sonucu vardı. Ratliff AVN sınıflamasına göre, 2 hastada tip 3 (%14.3) ve 1 hastada tip 1 (%7.1) AVN vardı.Sonuç: Sonuçlarımıza göre, pediatrik femur boyun kırıklarının tedavisinde anatomik redüksiyon (kapalı veya açık) ve stabil internal tespiti öneriyoruz.

Anahtar Kelimeler:

femoral boyun kırıkları, pediatri, yaralanmalar, avasküler nekroz

Clinical and Radiographic Outcomes of Pediatric Femoral Neck Fractures

Aim: The aim of this study was to evaluate the clinical and radiological results of pediatric femoral neck fractures and compare the results with the literature.Methods: We retrospectively reviewed patients with the diagnosis of femoral neck fracture who were treated between 2005 and 2012. 14 patients (6 girls, 8 boys) were found in compliance with the follow-up and with a minimum follow-up of 1 year. Causes of the fracture and types of the treatment were investigated from our medical records. Delbet-Colonna classification was used to determine the type of the fractures. At the last follow-up, femoral neck shaft angle (FNSA) and range of motion (ROM) of the affected hip were measured. Outcome was scored according to Ratliff’s assessment criteria. Avascular necrosis (AVN) was classified according to Ratliff’s AVN classification system. Results: The mean age of patients was 9.9 years and the mean follow-up was 35 months. According to Delbet-Colonna classification; 1 patient was type I (7.1%), 4 were type II (28.6%), 8 were type III (57.2%) and 1 was type IV (7.1%). Eight of 14 fractures were displaced (57.2%) and six were non-displaced (42.8%). Eleven of 14 patients had good (78.6 %), 1 had fair (7.1%) and 2 had poor (14.3%) results according to Ratliff’s assessment criteria. According to Ratliff’s AVN classification, 2 patients had Type-III (14.2 %) and 1 had Type-I AVN (7.1 %). Conclusion: According to our results, we recommend anatomical reduction (close or open) and stable internal fixation for the treatment of pediatric femoral neck fractures.

Keywords:

femoral neck fracture, pediatrics, injuries, avascular necrosis,

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1. Ratliff AH. Fractures of the neck of the femur in children. J Bone Joint Surg Br. 1962 Aug;44-B:528-42.
2. Lam SF. Fractures of the neck of the femur in children. J Bone Joint Surg Am. 1971 Sep;53(6):1165-79.
3. Canale ST, Bourland WL. Fracture of the neck and intertrochanteric region of the femur in children. J Bone Joint Surg Am. 1977 Jun;59(4):431-43.
4. Moon ES, Mehlman CT. Risk factors for avascular necrosis after femoral neck fractures in children: 25 Cincinnati cases and meta-analysis of 360 cases. J Orthop Trauma. 2006 May;20(5):323-9.
5. Yeranosian M, Horneff JG, Baldwin K, et al. Factors affecting the outcome of fractures of the femoral neck in children and adolescents: a systematic review. Bone Joint J. 2013 Jan;95-B(1):135-42.
6. Colonna PC. Fractures of the neck of the femur in children. Am J Surg 1929;6:793-7.
7. Forlin, E., Guille, J. T., Kumar, S. J. et al. Complications associated with fracture of the neck of the femur in children. Journal of Pediatric Orthopaedics. 1992; 12: 503-509.
8. Heiser JM, Oppenheim WL. Fractures of the hip in children: a review of forty cases. Clin Orthop Relat Res. 1980 Jun;(149):177-84.
9. Flynn JM, Wong KL, Yeh GL, Meyer JS, Davidson RS. Displaced fractures of the hip in children. Management by early operation and immobilisation in a hip spica cast. J Bone Joint Surg Br. 2002 Jan;84(1):108-12.
10. Shrader MW, Jacofsky DJ, Stans AA, Shaughnessy WJ, Haidukewych GJ. Femoral neck fractures in pediatric patients: 30 years experience at a level 1 trauma center. Clin Orthop Relat Res. 2007 Jan;454:169-73.
11. Varshney MK, Kumar A, Khan SA, et al. Functional and radiological outcome after delayed fixation of femoral neck fractures in pediatric patients. J Orthop Traumatol. 2009 Dec;10(4):211-6. doi: 10.1007/s10195-009-0072-4.
12. Azam MQ, Iraqi A, Sherwani M, et al. Delayed fixation of displaced type II and III pediatric femoral neck fractures. Indian J Orthop. 2009 Jul;43(3):253-8.
13. Dhar SA, Ali MF, Dar TA, et al. Delayed fixation of the transcervical fracture of the neck of the femur in the pediatric population: results and complications. J Child Orthop. 2009 Dec;3(6):473-7.
14. Nayeemuddin M, Higgins GA, Bache E, O'hara J, Glitheroe P. Complication rate after operative treatment of paediatric femoral neck fractures. J Pediatr Orthop B. 2009 Nov;18(6):314-9.
15. Dendane MA, Amrani A, El Alami ZF, et al. Displaced femoral neck fractures in children: are complications predictable? Orthop Traumatol Surg Res. 2010 Apr;96(2):161-5.
16. Song KS. Displaced fracture of the femoral neck in children: open versus closed reduction. J Bone Joint Surg Br. 2010 Aug;92(8):1148-51.
17. Bali K, Sudesh P, Patel S, et al. Pediatric femoral neck fractures: our 10 years of experience. Clin Orthop Surg. 2011 Dec;3(4):302-8.
18. Stone JD, Hill MK, Pan Z, et al. Open Reduction of Pediatric Femoral Neck Fractures Reduces Osteonecrosis Risk. Orthopedics. 2015 Nov 1;38(11):e983-90.
19. Morsy HA. Complications of fracture of the neck of the femur in children. A long-term follow-up study. Injury. 2001 Jan;32(1):45-51.
20. Inan U, Köse N, Omeroğlu H. Pediatric femur neck fractures: a retrospective analysis of 39 hips. J Child Orthop. 2009 Aug;3(4):259-64.
21. Kuo FC, Kuo SJ, Ko JY, Wong T. Complications of hip fractures in children. Chang Gung Med J. 2011;34(5):512-9.
22. Togrul E, Bayram H, Gulsen M, Kalaci A, Ozbarlas S. Fractures of the femoral neck in children: long-term follow-up in 62 hip fractures. Injury. 2005 Jan;36(1):123-30.
23. Panigrahi R, Sahu B, Mahapatra AK, Palo N, Priyadarshi A, Biswal MR. Treatment analysis of paediatric femoral neck fractures: a prospective multicenter theraupetic study in Indian scenario. Int Orthop. 2015 Jun;39(6):1121-7.