Orthopedic reduction and percutaneous fixation of femoral neck fractures in children

Fracture of the femoral neck is a rare injury in children but remains difficult problem and challenge with high rate of complications. Having in mind recommendations of the American Academy of Orthopaedic Surgeons, our effort was to improve treatment approach. In the period 1999 to 2004, five patients, aged 5 to 14 years, were treated by closed reduction and percutaneous pinning. All patients sustained high energy trauma and displaced femoral neck fractures, out of which two were transcervical, two cervicotrochanteric and one intertrochanteric. Procedures were performed under image amplifier. Hip decompression was achieved by needle aspiration via a subadductor approach. Three smooth Kirschner wires appeared to be stable and least aggressive fixation device, easy for applying and subsequent removal. We insisted on urgent treatment, anatomic alignment, stabile fixation and hip decompression. Excellent results were obtained in four patients who had undergone immediate treatment. Poor outcome with vascular necrosis in a five-year-old girl was attributed to five-day treatment delay. Suggested treatment, simple and applicable in practice, is aimed at reducing pathologic mechanisms crucial for development of complications.