Sharma Amit, Tiwari Anurag, Verma Tarun, Maini Lalit
Maulana Azad Medical College, Delhi, India.
J Clin Orthop Trauma. 2016 Oct-Dec;7(Suppl 1):8-11. doi: 10.1016/j.jcot.2016.10.014. Epub 2016 Nov 11.
Non-union is one of the devastating complications of fracture neck of femur. Though a very rarely encountered entity in a toddler (1-3 years paediatric age group), non-united femoral neck fractures are reported in developing countries because of mismanagement by quacks and delay in referrals. For operative treatment, many different procedures have been described, including close/open reduction and internal fixation using K-wires, cannulated screws, fibula or nails. There is no evidence in the literature that one or other implant influences the rate of postoperative complications, such as avascular femoral head necrosis or coxa vara. But, still the choice of fixation implant is debatable.
We present a case of 3-year-old child of non-union femoral neck fracture treated with valgus osteotomy. Choice of implant was kept to bare minimum to reduce the cost of implant and magnitude of surgery, which made the surgery minimally invasive, which is not the case in other studies. Two solid cancellous screws and a Kirschner wire (K-wire) were used to acheive fixation. Implant was removed after one year. The patient was followed up for 2 years and was found to be asymptomatic clinically with restoration of neck shaft angle and no signs of AVN.
Our method of intertrochanteric valgus osteotomy and internal fixation stabilized using K-wire and screws is a technically simple yet effective method of treating difficult fracture neck femur. Although a larger series and multicentric trails are needed, yet we would safely recommend extension of this technique to unstable fractures, to minimize the incidence of complications, cost and magnitude of surgery.
骨不连是股骨颈骨折最严重的并发症之一。虽然在幼儿（1 - 3岁儿童年龄组）中极为罕见，但由于庸医的不当治疗和转诊延误，发展中国家仍有股骨颈骨折不愈合的报道。对于手术治疗，已经描述了许多不同的方法，包括闭合/开放复位以及使用克氏针、空心螺钉、腓骨或髓内钉进行内固定。文献中没有证据表明某一种植入物会影响术后并发症的发生率，如股骨头缺血性坏死或髋内翻。但是，固定植入物的选择仍然存在争议。
我们报告一例3岁儿童股骨颈骨折不愈合，采用外翻截骨术治疗。为降低植入物成本和手术规模，将植入物的选择保持在最低限度，这使得手术具有微创性，这与其他研究情况不同。使用两枚实心松质骨螺钉和一根克氏针进行固定。一年后取出植入物。对患者进行了2年的随访，发现其临床无症状，颈干角恢复，且无股骨头缺血性坏死迹象。
我们采用的粗隆间外翻截骨术并用克氏针和螺钉进行内固定的方法，在技术上简单但有效地治疗了复杂的股骨颈骨折。尽管需要更大规模的系列研究和多中心试验，但我们仍安全地推荐将该技术扩展应用于不稳定骨折，以尽量减少并发症的发生率、成本和手术规模。
