Schneidmueller Dorien, Hungerer Sven, Stuby Fabian, Glowalla Claudio
Kindertraumatologie, BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau am Staffelsee, Deutschland.
Institut für Biomechanik der PMU Salzburg, BG Unfallklinik Murnau, Murnau am Staffelsee, Deutschland.
Oper Orthop Traumatol. 2021 Feb;33(1):23-35. doi: 10.1007/s00064-020-00692-6. Epub 2021 Jan 19.
Anatomic reduction and stable fixation of pediatric femoral neck fractures.
All unstable and displaced femoral neck fractures (AO classification 31-E/1.1, 31-E/1.2, 31-M/2.1 I-III, 31-M/3.1 I-III, 31-M/3.2 II-III).
Relative: Stable and nondisplaced femoral neck fractures.
The anterolateral approach uses the muscle interval between the gluteus medius and minimus muscles and the tensor fascia lata. It provides access to the anterior part of the hip joint for open reduction and allows the retention and osteosynthesis from the lateral aspect of the femur. By incision of the anterior capsule the blood supply of the femoral head is preserved and the fracture can be visualized. An anatomic reduction should be achieved and a stable osteosynthesis according to the age of child and fracture type and location should be performed.
After stable fixation additional immobilization is not required. Young children are mobilized in a wheel chair with no weight bearing; older children are mobilized with partial weight bearing with crutches. According to the age of the child and fracture type full weight bearing can be allowed after 4-8 weeks after radiographic follow-up.
Fractures of the femoral neck in children are rare and often associated with high-energy traumata. Complication rates are high such as avascular necrosis (AVN) of the femoral head, premature epiphyseal closure, nonunion, secondary displacement, coxa vara or infection. Different factors influence the outcome, including initial displacement, fracture classification, timing of reduction, stability of fixation or quality of reduction. However, especially in the lateral fractures the femoral head necrosis can be avoided by protecting the vascular supply. The reader of the article should be enabled to reduce the rate of AVNs by knowledge of the controllable risk factors and no longer accept AVN as predestined. There is a controversial discussion on the benefit of hematoma evacuation of the hip joint capsule and its influence on the rate of femoral head necrosis.
实现儿童股骨颈骨折的解剖复位及稳定固定。
所有不稳定及移位的股骨颈骨折（AO分类31-E/1.1、31-E/1.2、31-M/2.1 I-III、31-M/3.1 I-III、31-M/3.2 II-III）。
相对禁忌症：稳定且无移位的股骨颈骨折。
前外侧入路利用臀中肌和臀小肌之间以及阔筋膜张肌的肌间隙。它为髋关节前部提供了开放复位的入路，并允许从股骨外侧进行固定和骨合成。通过切开前方关节囊可保留股骨头的血供并可直视骨折部位。应进行解剖复位，并根据患儿年龄、骨折类型和部位进行稳定的骨合成。
稳定固定后无需额外制动。幼儿在轮椅上活动，不负重；大龄儿童借助拐杖部分负重活动。根据患儿年龄和骨折类型，影像学随访4-8周后可允许完全负重。
儿童股骨颈骨折罕见，常与高能量创伤相关。并发症发生率高，如股骨头缺血性坏死（AVN）、骨骺过早闭合、骨不连、继发移位、髋内翻或感染。不同因素影响预后，包括初始移位、骨折分类、复位时机、固定稳定性或复位质量。然而，特别是在外侧骨折中，通过保护血供可避免股骨头坏死。文章读者应通过了解可控风险因素来降低AVN发生率，而不应再将AVN视为注定会发生的情况。关于髋关节囊血肿清除的益处及其对股骨头坏死发生率的影响存在争议性讨论。
