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    Fracture Neck of Femer

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    Jawad Khan
    1) Fractures of the neck of the femur are rare in pediatric patients, accounting for less than 1% of all fractures and hip fractures. 2) The key growth centers of the proximal femur are the proximal femoral epiphysis and the trochanteric apophysis. Injury to these growth centers can lead to leg length discrepancies. 3) Treatment options depend on the Delbet classification of the fracture and include non-operative treatment with spica casting for non-or minimally displaced fractures, as well as closed or open reduction with internal fixation for displaced fractures.

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    Fracture Neck of Femer

    Uploaded by

    Jawad Khan
    43 views28 pages
    1) Fractures of the neck of the femur are rare in pediatric patients, accounting for less than 1% of all fractures and hip fractures. 2) The key growth centers of the proximal femur are the proximal femoral epiphysis and the trochanteric apophysis. Injury to these growth centers can lead to leg length discrepancies. 3) Treatment options depend on the Delbet classification of the fracture and include non-operative treatment with spica casting for non-or minimally displaced fractures, as well as closed or open reduction with internal fixation for displaced fractures.

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    Ortho_Lecture

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    FRACTURE NECK OF FEMER

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    1) Fractures of the neck of the femur are rare in pediatric patients, accounting for less than 1% of all fractures and hip fractures. 2) The key growth centers of the proximal femur are the proximal femoral epiphysis and the trochanteric apophysis. Injury to these growth centers can lead to leg length discrepancies. 3) Treatment options depend on the Delbet classification of the fracture and include non-operative treatment with spica casting for non-or minimally displaced fractures, as well as closed or open reduction with internal fixation for displaced fractures.

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    Download as pptx, pdf, or txt
    43 views28 pages

    Fracture Neck of Femer

    Uploaded by

    Jawad Khan
    1) Fractures of the neck of the femur are rare in pediatric patients, accounting for less than 1% of all fractures and hip fractures. 2) The key growth centers of the proximal femur are the proximal femoral epiphysis and the trochanteric apophysis. Injury to these growth centers can lead to leg length discrepancies. 3) Treatment options depend on the Delbet classification of the fracture and include non-operative treatment with spica casting for non-or minimally displaced fractures, as well as closed or open reduction with internal fixation for displaced fractures.

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    FRACTURE NECK OF

    FEMER
    Dr Mumtaz Hussain
    Assistant Professor
    Department of Pediatric Orthopedics
    The Children’s Hospital & The Institute
    of Child Health Lahore
    Epidemiology
    account for <1% of all fractures in pediatric patients
    <1% of all hip fractures

     Boardman M, Herman M, Buck B, Pizutillo P. Hip Fractures in Children. JAAOS. 2009;17:162-


    173.
    GROWTH CENTERS OF PROXIMAL FEMER
    Proximal femoral epiphysis
    ◦ accounts for 13-15% of leg length
    ◦ accounts for 30% length of femur
    ◦ proximal femoral physis grows 3 mm/yr
    ◦ entire lower limb grows 23 mm/yr
     Trochanteric apophysis
    ◦ Traction apophysis
    ◦ contributes to femoral neck growth
     injury to the GT apophysis leads to shortening of the GT and
    coxa valga
    overgrowth of the GT apophysis leads to coxa vara
    BLOOD SUPPLY
     Lateral Femoral Circumflex Artery
    ◦ regresses in late childhood
     Artery Of The Ligamentum Teres
    ◦ diminishes after 4 years old
    Metaphyseal Vessels
    ◦ also contribute to blood supply to the head < 3 years
    old
    Medial Femoral Circumflex Artery
    ◦ main blood supply to the head via the posterosuperior
    lateral epiphyseal branch and via posteroinferior
    retinacular branch becomes main blood supply after 4 years
    after regression of LFCA and artery of ligamentum teres
    Delbet Classification
    Type Description Incidence AVN Nonunion

    Type I Transphyseal (IA, <10% 38%


    withoutdislocation of epiphysis from
    acetabulum; IB, with dislocation of epiphysis)
    Type II Transcervical 40-50% 28% 15%
    Type III Cervicotrochanteric 30-35% 18% 15-20% (or
    basicervical)
    Type IV Intertrochanteric 10-20% 5% 5%
    TREATMENT
    NON OPERATIVE
    Spica cast in abduction, weekly radiographs for 3 wks
    Indication:
    Type IA, II, III, IV nondisplaced, age <4 yrs
    TREATMENT
    Close reduction internal fixation(CRIF), Per
    cutaneous pinning (CRPP)
    Indication:
    Type II, III, IV, displaced, older child
    Open reduction internal fixation(ORIF)
    Indication:
    Type IB
    Pediatric hip screw/ DHS
    Indication:
    Type IV
    TREATMENT
    ORIF & Capsulotomy and joint aspiration
     Indication:
     Open hip fracture
     Major Vessel injury
     Concomitant hip dislocation, significant displacement
     Type I
    Complications
    Avascular necrosis
    Coxa vara
    Non-union
    Limb length discripency
    Chondrolysis
    Infection
    Complications
    Avascular necrosis
    most common complication
    ◦ most susceptible age for AVN is 3-8 years
    ◦ risk of AVN is highest for Delbet type I and nearly
    100% for Delbet type IB
    Etiology
    ◦ kinking of vessels
    ◦ laceration of vessels
    ◦ tamponade by intracapsular hematoma
    Treatment
    ◦ core decompression
    ◦ vascularized fibular graft
    Complications
    Coxa Vara (neck-shaft angle <115deg)
    2nd most common complication
    more common if fracture is treated nonoperatively
    more common for types I, II and III
    ◦ incidence 25% for type III
    Complications
    Treatment
    young patients (0-3yrs) will remodel
    surgical arrest of trochanteric apophysis
    indication
     coxa vara in <6-8yrs
    subtrochanteric or intertrochanteric valgus
    osteotomy
    indication
     coxa vara + nonunion
    Delbet III with nonunion

    Pre op post op 3 months postop


    Complications
    Nonunion
    can occur together with coxa vara
    Etiology
    nonoperative treatment of Type II or III
    occult infection at fracture site
    severe AVN of proximal femur
    Treatment
    subtrochanteric or intertrochanteric valgus osteotomy
    Complications
    Limb length discrepancy
    significant LLD occurs in combined AVN + physeal
    arrest
    Treatment
    shoe lift
     Indications
     projected LLD at skeletal maturity <2cm

    epiphysiodesis of contralateral distal femur and/or


    proximal tibia
     Indications
     projected LLD at skeletal maturity 2-5cm
    Complications
    Chondrolysis
    usually associated with AVN
    Etiology
    poor vascularity to femoral head cartilage
    persistent hardware penetration of joint
    presents as restricted hip motion, hip pain,
    radiographic joint space narrowing
    Complications
    Infection
    <1% incidence
    after ORIF or CRPP
    Treatment
     debridement, maintain fixation until union
    may lead to osteomyelitis, AVN, chondrolysis,
    premature physeal closure
    Delbet type II

    Pre op 6wks postop 1 yr postop


    THANK YOU

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