Nan Guoxin,Xu Weisen,Cai Wenquan,et al.Experience of treating femoral neck fractures in children through a direct anterior approach[J].Journal of Clinical Pediatric Surgery,,():361-366.[doi:10.3760/cma.j.cn101785-202403060-011]
Experience of treating femoral neck fractures in children through a direct anterior approach
- Keywords:
- Femoral Neck Fractures; Surgical Procedures; Operative; Fracture Fixation; Internal; Treatment Outcome; Child
- Abstract:
- Objective To explore a simple and mini-invasive surgical approach for femoral neck fracture in children. Methods From February 2017 to January 2023,retrospective review was performed for the relevant clinical data of 13 children with femoral neck fractures undergoing incisional reduction,compression screw or Kirschner pin fixation at Chongqing Children’s Hospital and Dongguan Children’s Hospital.There were a total of 14 sides.One epileptic child had bilateral femoral neck fractures occurring sequentially 6 months apart.There were 10 boy and 3 girls with a mean age of 6.5(3.2-8.2) year.Delbet type was Ⅰ (n=2),Ⅱ (n=9,10 sides) and Ⅲ (n=2).All cases exhibited significant fracture displacement or angular deformity pre-operation.Operation was performed under general anesthesia.After location was located under a C-arm,target location was marked and direct anterior approach (DAA) adopted.After incising skin and subcutaneous fat,proximal lateral side of rectus femoris muscle was bluntly dissected and proximal end of muscle retracted medially,exposing anterior part of hip joint capsule.For type Ⅰ/Ⅱ fracture,joint capsule was opened and assisted traction plus reduction were performed under a direct vision.Then after inserting guide wires and confirming a correct position,two hollow compression screws with a diameter of 4.0 mm were used for fixation.For type Ⅰ fractures,3-4 Kirschner needle with a diameter of 2.0 mm was utilized for fixation.After surgery,they were immobilized with a hip brace or cast for 6 weeks and then removed.At Month 3 post-operation,weight-bearing activities at affected side were avoided and monthly follow-ups conducted.At Month 6 post-operation,internal fixation was removed and MRI performed for eliminating the possibility of avascular necrosis of femoral head.Collect information on incision length,operative time,intraoperative bleeding,reduction and complications in all patients. Results The incision length ranged from 3.0 to 3.5 cm with a mean length of 3.2 cm.No muscle tissue was incised intraoperatively.Average operative duration was 36(33-42) min.Intraoperative hemorrhage had a mean volume of 12.3(12-20) mL.Postoperative radiography confirmed anatomical realignment in all cases.Internal fixation was removed at a mean time of 6.8(6-12) month.One child of type Ⅰ fracture resulting in ischemic necrosis of the femoral head was identified through MRI after Kirschners pin removal. Conclusions DAA is suitable for treating pediatric femoral neck fractures.This approach may provide a distinct exposure of fracture site,cause mini-trauma and does not disrupt the integrity of anterior muscles.Allowing for fast postoperative functional recovery,it has a low incidence of complications,making it a simple and feasible surgical approach for femoral neck fractures.
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Memo
收稿日期:2023-08-08。
通讯作者:南国新,Email:ngx1215@126.com