We studied 21 cases of displaced femoral neck fractures presenting to us over a period of 11 years in a retrospective−prospective manner to determine radiological and functional outcomes of delayed fixation, factors influencing outcomes, and whether capsular decompression has a role in the initial management of these fractures. The role of capsular decompression also has not been reasonably established considering the fact that primary injury to vascularity occurs at the time of initial injury. Causes of complications have been established by retrospective evaluation, with only a few studies documenting the development of complications after temporal delay in fixation. Primarily, complications have been linked to delayed treatment, fracture type and patient age, inadequate reduction, and fixation failure. These fractures are known to have a high complication rate, including osteonecrosis of the femoral head (the most common and disabling complication), chondrolysis, nonunion, premature physeal closure, coxa vara, and limb-length discrepancies. Inadvertent delay in fixation may occur and are not uncommon in developing countries due to a variety of reasons. The treatment of choice for displaced fractures is emergent closed or open reduction and internal fixation as early as possible. Capsular decompression does not seem to affect the outcome in delayed presentations and may hinder definitive treatment.įemoral neck fractures in children are uncommon, accounting for <1% of all fractures in pediatric patients. Osteonecrosis is primarily linked to delay and open reduction, whereas fracture type, age, and sex seem insignificant factors. Outcome following temporal delay in fracture fixation of the femoral neck is primarily affected by osteonecrosis of the femoral head, whereas restriction of movements, shortening, and premature physeal closure has no significant influence. There was a significant correlation ( r = 0.52) between development of osteonecrosis and delayed fracture fixation of >10 days ( P = 0.016) and open reduction ( P = 0.016). Three (14.3%) patients had osteonecrosis of the hip, which was significantly related to poor outcome ( r = 0.495 P = 0.022). ResultsĪll fractures united at a mean duration of 12 (range 10.6–14) weeks. Patients were followed for a mean of 81 (range 66–129) months. Results were assessed on the basis of modified Ratliff criteria. Patients were allowed full weight bearing after 12–18 weeks. Extraphyseal fixation was done using partially threaded cannulated cancellous screws after closed or open reduction. Radiological and functional evaluation was done for delayed fixation (>24 h) of displaced fractures in the femoral neck in 21 children (21 hips) treated over 11 years. Also, the role of capsular decompression in initial management needs to be elucidated. Prospective evaluation of results after delayed fixation of femoral neck fractures in children beyond the first 24 h is not reported in the literature and requires evaluation to increase our understanding of the procedure and improve fixation methods. Complications that develop after femoral neck fracture in children-especially osteonecrosis-have been retrospectively attributed to inadvertent delayed fixation and fracture type.
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