[Closed reduction and internal fixation of pediatric femoral neck fractures]. / Geschlossene Reposition und perkutane Osteosynthese der Schenkelhalsfraktur im Kindesalter.

ABSTRACT

OBJECTIVE: To achieve anatomical reduction and stable fixation. Preservation of the proximal femoral physis is in this regard secondary. INDICATIONS Nondisplaced and displaced femoral neck fractures Delbet types II and III. Incomplete fractures are debatable. No age restrictions. CONTRAINDICATIONS Any patient condition that does not allow for general or regional anesthesia. Pathologic fractures requiring primarily an open approach. SURGICAL TECHNIQUE Anatomical reduction is achieved via axial tension, internal rotation and gentle abduction or flexion of the affected hip and verified under image intensification; several stab incisions or a small single incision (3 cm) laterally at the level of the lesser trochanter to determine the entry points for the K­wires or screws; inserting and positioning the K­wires either as a configuration of two or three; depending on the bony dimensions fixation of the fracture with the K­wires or replacing them with cannulated screws; the localization of the main fracture line (basicervical or subcapital) determines whether the implants should cross the physis. POSTOPERATIVE MANAGEMENT Partial weight bearing/touch ground (about 20% of bodyweight) for 6 weeks; either by using crutches or via mobilization in buggy or wheelchair. RESULTS: As an example, we present a case of a 9-year-old girl suffering from a displaced femoral neck fracture (Delbet type II) on the left side, who underwent closed reduction and internal screw fixation. Fracture healing and follow-up until today were uneventful. A brief review of the published literature is also provided.