[Lateral approach to pediatric femoral neck fractures].

OBJECTIVE

Illustration of surgical treatment of all types of femoral neck fractures other than type AO 31-E/2.1 (Delbet type IB) through the lateral approach INDICATIONS: Femoral neck fractures: a) transcervical (type AO 31-E/1.1) or Delbet type IA, respectively; b) medial femoral neck fracture (type AO 31-M/3.1 I) or Delbet type II, respectively; c) lateral femoral neck fracture (type AO 31-M/3.1 II) or Delbet type III, respectively; d) intertrochanteric (type AO 31-M/3.1 III) or Delbet type IV, respectively.

CONTRAINDICATIONS: Transepiphyseal fracture with dislocation (type AO 31-E/2.1) or Delbet type IB, respectively SURGICAL TECHNIQUE: Open reduction of femoral neck fractures using lateral approach.

POSTOPERATIVE MANAGEMENT: Early functional treatment with full range of motion of the hip joint immediately postoperatively. Amount of weight bearing depending on the geometry of the fracture.

RESULTS

In a retrospective study, 33 children (19 boys and 14 girls) with a femoral neck fracture were followed-up for at least one year (average follow-up was 1.6 years). Average age of the included patients was 9.7 years (range 1-16 years). Three fractures were treated conservatively with pelvic leg plaster and 30 were openly reduced and stabilized. The fractures were classified according to Delbet. There were 2 type I fractures (transepiphyseal), 12 type II fractures, 10 type III fractures and 9 type IV fractures. A very good result was achieved in 29 children (88%). The most common complication was avascular necrosis (AVN), which was observed in 3 patients, all of whom showed an unsatisfactory result. Another complication was a screw breakout that resulted in a screw change. This child also showed an unsatisfactory result. Lateral access is a standard access in traumatology as well as pediatric orthopedics which can be used safely and with few complications even in children.