Fracture of the neck and intertrochanteric region of the femur in children

Abstract

End-result evaluations after an average follow-up of seventeen years are reported in sixty-one cases (sixty patients). There were five Type-1 (transepiphyseal), twenty-seven Type-II (transcervical), twenty-two Type-III (cervicotrochanteric), and seven Type-IV (intertrochanteric) femoral fractures. The majority of Type-I, Type-II, and displaced Type-III fractures were treated with closed or open reduction and Knowles-pin fixation. The majority of undisplaced Type-III and Type-IV fractures were treated with abduction plaster spica casts. Fifty-five per cent were found to have good resultswhile 20% were fair and 25%, poor. The incidence of complications--avascular necrosis, coxa vara, premature epiphyseal closure, infection, and non-union--was compared with that in previously reported series. The use of Knowles-pin fixation appeared to reduce the complications of non-union and coxa vara. Avascular necrosis caused most of the poor results. However, younger children with avascular necrosis obtained better results than did older ones. Some children with results graded as poor roentgenographically were only mildly symptomatic.