Pediatric Femoral Neck Fracture

• synonyms:

ICD-9

Etiology / Epidemiology / Natural History

• High risk of AVN and long term disability

Anatomy

Clinical Evaluation

Xray / Diagnositc Tests

Classification / Treatment

• Urgent reduction, fixation and decompression are indicated to reduce risk of AVN and long term disability.
• Type I( transepiphyseal), age <8y/o: smooth pins across the physis, decompression and spica casting for 4-6 weeks. high risk of AVN.
• Type I( transepiphyseal), age >8y/o: 4.5mm or 7.3mm screws and decompression. high risk of AVN.
• Type II(transcervical), age <3y/o: smooth pins across the physis, decompression and spica casting for 4-6 weeks.
• Type II (transcervical), age 3-10yrs old: 4.5mm or 7.3mm screws (not crossing physis), decompression and spica casting for 4-6 weeks.
• Type II (transcervical), >10yrs old: 7.3mm screws across the physis and decompression.
• Type III (cervicotrochanteric), age <3y/o: smooth pins across the physis and decompression and spica casting for 4-6 weeks.
• Type III (cervicotrochanteric), age 3-10yrs old: 4.5mm or 7.3mm screws (not crossing physis), decompression and spica casting for 4-6 weeks.
• Type III (cervicotrochanteric), >10yrs old: 7.3mm screws across the physis and decompression.
• Type IV(peritrochanteric): sliding hip screw and decompression in all patients. Lowest risk of AVN
• Delbert Classification

Associated Injuries / Differential Diagnosis

Complications

• Avascular necrosis: up to 42%.
• Coxa Vera
• Nonunion
• Malunion

Follow-up Care

Review References

• Cheng JC, JPO 1999;19:338.
• Flynn JM, JBJS 2002;84Br:108
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