Chen Jinchen,Chen Shunyou,Pan Yuancheng.Analysis of screw depth for therapeutic efficacy of Delbet type Ⅱ/Ⅲ femoral neck fractures in children[J].Journal of Clinical Pediatric Surgery,,19():573-578.[doi:10.3969/j.issn.1671-6353.2020.07.003]
Analysis of screw depth for therapeutic efficacy of Delbet type Ⅱ/Ⅲ femoral neck fractures in children
- CLC:
- R726.8;R683.42;R687.3+2
- Abstract:
- Objective To explore the therapeutic efficacy of screw depth for Delbet type Ⅱ/Ⅲ femoral neck fractures in children.Methods Retrospective analysis was performed for clinical data of screw-treated children with Delbet type Ⅱ/Ⅲ femoral neck fractures from June 2011 to April 2019.Proximal femur was divided into six zones and the term "internal fixation span" defined as zone number of internal fixation end minus zone number of fracture line.Operative age,open versus close reduction,quality of reduction,internal fixation end zone,fracture line zone,internal fixation span,displacement,nonunion,avascular necrosis,coxa vara and femural neck shortening were analyzed.Results A total of 37 children were recruited.There were 19 boys and 18 girls with a mean age of 10.5(4-16) years and a mean follow-up period of 23.4 months.Fracture lines were located in zone 1 (n=12),zone 2 (n=20),zone 3 (n=5) and zone 4/5 (n=0).The children whose fracture lines located in zone 3 was significantly older than those in zone 1/2 (P<0.05).Internal fixation span was at least 2 zones in all children.Six cases (16.2%) had avascular necrosis and avascular necrosis had no relationship with zone end of internal fixation (P>0.05).The complications of displacement,nonunion,coxa vara and femoral neck shortening were all accompanied by avascular necrosis.Conclusion Most cases of Delbet type Ⅱ/Ⅲ femoral neck fractures are located in zone 1/2 at a relatively young age.And internal fixation span at least 2 zones can achieve stability.No obvious relationship exists between transphyseal internal fixation and avascular necrosis.
References:
1 Patterson JT,Tangtiphaiboontana J,Pandya NK,et al.Management of pediatric femoral neck fracture[J].J Am Acad Orthop Sur,2018,26(12):411-419.DOI:10.5435/JAAOS-D-16-00362.
2 Hughes LO,Beaty JH.Fractures of the head and neck of the femur in children[J].J Bone Joint Surg Am,1994,76(2):283-292.DOI:10.2106/00004623-199402000-00019.
3 Hajdu S,Oberleitner G,Schwendenwein E,et al.Fractures of the head and neck of the femur in children:an outcome study[J].Int Orthop,2010,35(6):883-888.DOI:10.1007/s00264-010-1039-z.
4 Dial B,Lark R.Pediatric proximal femur fractures[J].J Orthop,2018,15(2):529-535.DOI:10.1016/j.jor.2018.03.039.
5 Panigrahi R,Sahu B,Mahapatra AK,et al.Treatment analysis of paediatric femoral neck fractures:a prospective multicenter therapeutic study in Indian scenario[J].Int Orthop,2015,39(6):1121-1127.DOI:10.1007/s00264-015-2677-y.
6 Song K.Displaced fracture of the femoral neck in children:open versus closed reduction[J].J Bone Joint Surg Br,2010,92(8):1148-1151.DOI:10.1302/0301-620X.92B8.24482.
7 Colonna PC.Fracture of the neck of the femur in children[J].Am J Surg,1929,6(6):793-797.DOI:10.1016/S0002-9610(29)90726-1.
8 Togrul E,Bayram H, Gulsen M,et al.Fractures of the femoral neck in children:long-term follow-up in 62 hip fractures[J].Injury,2005,36(1):123-130.DOI:10.1016/j.injury.2004.04.010.
9 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].J Orthop Trauma,2006,20(5):323-329.DOI:10.1097/00005131-200605000-00005.
10 Shrader MW,Jacofsky DJ,Stans AA,et al.Femoral neck fractures in pediatric patients:30 years experience at a level 1 trauma center[J].Clin Orthop Relat Res,2007,454:169-173.DOI:10.1097/01.blo.0000238794.82466.3d.
11 Eberl R,Singer G,Ferlic P,et al.Post-traumatic coxa vara in children following screw fixation of the femoral neck[J].Acta Orthop,2010,81(4):442-445.DOI:10.3109/17453674.2010.501744.
12 Spence D,Di Mauro JP,Miller PE,et al.Osteonecrosis after femoral neck fractures in children and adolescents:analysis of risk factors[J].J Pediatr Orthop,2016,36(2):111-116.DOI:10.1097/BPO.0000000000000424.
13 Stone JD,Hill MK,Pan Z,et al.Open reduction of pediatric femoral neck fractures reduces osteonecrosis risk[J].Orthopedics,2015,38(11):e983-e990.DOI:10.3928/01477447-20151020-06.
14 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[J].Bone Joint J,2013,95-B(1):135-142.DOI:10.1302/0301-620X.95B1.30161.
15 Wang WT,Li YQ,Guo YM,et al.Risk factors for the development of avascular necrosis after femoral neck fractures in children:a review of 239 cases[J].Bone Joint J,2019,101-B(9):1160-1167.DOI:10.1302/0301-620X.101B9.BJJ-2019-0275.R1.
Memo
收稿日期:2020-05-12。
基金项目:福建省卫生计生科研人才培养医学创新课题项目（编号：2017-CX-46）
通讯作者:陈顺有,Email:csy508@163.com