[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.