1. FEMORAL NECK FRACTURES IN
CHILDREN - REVIEW OF CASE SERIES
ON FIVE PATIENTS MANAGED AT
THE NATIONAL ORTHOPAEDIC
HOSPITAL, DALA-KANO
NOA CONFERENCE “IFE 2012”

2. AUTHORS: Isa N, Salihu MN, Alada
AA, Alabi IA, Arinze A and Tella AO
National Orthopaedic Hospital,
Dala-Kano, Nigeria.

3. INTRODUCTION
• Femoral neck fractures are rare conditions in
children.
• Most of the fractures result from high-energy
trauma.
• Complications are associated with serious
long-term morbidities.

4. INTRODUCTION
“ Hip fractures in children are of
interest because of the frequency of
complications rather than the
frequency of fractures.”[1] - CANALE

5. AIMS/OBJECTIVES
• The aim was to evaluate the pattern of
presentation, clinical outcome and
complications associated with the
management of paediatric femoral neck
fractures at NOH, Dala-Kano.

6. PATIENTS AND METHOD
• The study reviewed the clinical records of
paediatric patients presenting with femoral
neck fractures or its complication managed
at the NOH, Dala-Kano, between May 2008
and June 2012.
• Inclusion criteria:
- Age 16 years at the time of injury˂
- Complete radiographic records

7. PATIENTS AND METHOD
• Eight patients were managed but only five
met criteria for analysis .
• Delbet classification was used.
• All patients had operative treatment with
either cannulated screws alone or primary
osteotomy stabilized with paediatric
osteotomy plate.
• Ratliff criteria was used for outcome analysis
in 4 of the 5 patients, who had completed 1
year follow-up.

8. A. Pre-op. B. 6-weeks post-op. C. Follow-up at 1 year

9. A. Pre-op B. Immediate post-op C. 3-month post-op

10. A. Pre-op B. 6 weeks post-op C. 1-year post-op.

11. RESULTS
• Patient Demographics:
Patient characteristics No of cases Remarks
Gender
-Male
-Female
4
1
Age range (in years)
0-5
6-10
11-15
0
2
3
Laterality of Facture
-Right
-Left
0
5

12. RESULTS
• Mechanism of injury:
No of cases Remarks
Fall from height
- storey building
- tree top
1
2
RTA
- MV-pedestrian
- Motorcycle
1
1

13. RESULTS
• Associated injuries:
No of cases Percentage
Facial injury 1
Blunt chest injury 2
No assoc. injury 2

14. RESULTS
Patient Duration of
injury
Mode of
presentation
Delbet
type
Treatment
1 10 days Painful limp II ORIF +
Cannulated
screws
2 3 weeks Painful limp, LLD III Osteotomy
plate + screw
3 4 months Malunion, coxa
vara, LLD
III Osteotomy
plate only
4 7 months Malunion, coxa
vara, LLD
III Osteotomy
plate only
5 9 months Non-union, coxa
vara, LLD
II Osteotomy
plate + Screw

15. RESULTS
• OUTCOME OF TEATMENT:
Patient Delbet type Complications Ratliff outcome
1 II - Good
2 III - -
3 III Surgical site
infection
Good
4 III Premature
physeal closure
(LLD-6cm)
Fair
5 II Avascular
necrosis
Fair

16. DISCUSSION
• Paediatric femoral neck fractures are
uncommon.
• The average incidence, worldwide is 1% of˂
all paediatric fractures [1,2,3,4,5].
- May be higher in our environment [6].
• Most cases result from high-energy trauma.

17. DISCUSSION
• The presence of physis and vascular
peculiarities make paediatric femoral neck
fractures an important clinical entity.
• The risk of severe complications like AVN and
growth arrest, make prompt treatment of
paediatric femoral neck fractures a priority.

18. DISCUSSION
• Delbet classified these fractures into 4 types
- Type I : Transepiphyseal (5-10%)
- Type II : Transcervical (50%)
- Type III : Cervico-trochanteric or Basal (35%)
- Type IV : Intertrochanteric (10-15%)
• Our study revealed more of type III (3
patients).

19. DISCUSSION
• Three of our patients, presented late with
complications – malunion, nonunion and
coxa vara.
• Initial TBS involvement in 3 patients
- Remaining 2 cases were referrals
• We offered 4 of our patients primary
osteotomy due to the mode of presentation.

20. DISCUSSION
• Of all the complications reported in the
literature, AVN is the most common and
most devastating [7,8].
• Quick et al [9], reported an average incidence
of 6-53% for AVN in paediatric femoral neck
fractures.
• In our study, AVN occurred in 1 patient, and
risk factors identified include:
- Type of fracture and displacement
- Late presentation.

21. DISCUSSION
• A case of premature physeal closure
occurred, with worsening LLD at follow-up.
• Residual coxa vara also seen in 2 patients.
• Other complication seen was surgical site
infection in 1 patient.

22. DISCUSSION
• Ratliff criteria:

23. CONCLUSION
• The clinical outcome of our study was mainly
influenced by late presentation.
• Malunion, Nonunion and coxa vara were
seen as primary complications rather than
secondary.
• Based on Ratliff criteria, at the end of 1 year,
2 of our patients had satisfactory outcome.

24. MANY THANKS

25. REFERENCES
• 1) 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):431–443.
• 2) Bali et al. Paediatric Femoral Neck Fractures. Clinics in
Orthop. Surg. 2011; Vol.3 No. 4; 302-308.
• 3) Arora et al. Outcomes in Paediatric Femoral Neck
Fractures. Delhi J. of Orthop. 2004; 1: 25-49.
• 4) Bimmel et al. Paediatric Hip Fractures: A systematic review
of incidence, treatment options and complications. Acta
Orthop. Belg. 2010; 76; 7-13.
• 5) Feng-Chih Kuo et al. Complications of paediatric hip
fractures. Cnang Gung Med J. 2011; Vol.34, No. 5

26. REFERENCES
• 6) Nwadinigwe et al. Fractures in children. Nigerian J of
medicine. Jan-Mar 2006; Vol. 15, No. 1,
• 7) Ratliff. Fractures of the neck of the femur in children. J
Bone Joint Surg Br. 1962;44-B:528–542.
• 8) Pedro et al. Nonunion of fractures of the femoral neck in
children. J Child Orthop. 2008; 2: 97-103
• 9) Quick TJ, Eastwood DM. Pediatric Fractures and
Dislocations of the Hip and Pelvis. Clin Orthop Relat Res.
2005;432:87–96