Between the sartorius and tensor fasciae latae, the anterior hip approach was performed to reach the capsule of the hip joint and the dissection was made throughout the layers.
Femoral neck fracture trial#
A trial of closed reduction failed, thus the surgical team moved to an open reduction technique. An image intensifier was used as an intraoperative assessment of the fracture reduction and implant placement.
Femoral neck fracture full#
The patient was taken to the operative room and placed in the supine position under general anesthesia with a full aseptic technique. The patient underwent a clinical assessment by an anesthesiologist for an urgent operative intervention to fix the fracture. Case PresentationĪfter studying the x-rays and CT scans for the pelvis, treatment options were discussed with the patient's family (Figure 3). Debate exists on whether radiographic evidence of sclerotic changes associated with Ratliff type III fracture reflects osteonecrosis rather than routine fracture healing. Sub-capital or Salter-Harris type I fractures with complete dislocation of the epiphysis (i.e., Delbet type IB) are universally thought to progress to osteonecrosis regardless of treatment. Many authors report that the long-term outcomes of management of Delbet type I fractures are worse when compared to other Delbet type fractures. Ratliff classified acute osteonecrosis of the femoral head and neck as radiographic sclerosis and collapse of the head (type I), focal sclerosis superior lateral head (type II), or sub-capital neck (type III) with preservation of the epiphyseal supply. And is secondary to a disruption of the vascular supply to the femoral head. Osteonecrosis occurs in 16-47% of pediatric proximal femoral fractures. This anatomic fracture classification is prognostic of long-term outcomes as well as the main complication of pediatric femoral neck fractures, osteonecrosis. Type I fractures are transphyseal, while types II, III, and IV are transcervical, cervicotrochanteric, and intertrochanteric fractures, respectively. Classification of proximal femur fractures in pediatricsĭelbet classification of proximal femoral fractures, which is a fracture classification guide now regularly used to educate patients on the risks of possible complications prior to initiating treatment. Open injuries and neurovascular status must be evaluated. Therefore, specific attention must be paid in collaboration with general surgery and neurosurgery to identify other associated injuries, specifically non-musculoskeletal injuries. Īpproximately, half of all proximal femur fractures in pediatrics are the result of the high mechanism of injury, such as a road traffic accident, and can be related to serious injuries, consisting of injury to the head, chest or abdomen, pelvic ring injury, acetabular fracture, hip dislocation, and ipsilateral femur fracture. These complications are due to osteonecrosis, coxa valga, proximal femoral physeal growth arrest, and non-union. Dysfunction and pain are the most frequently reported complications in 20-50% of all patients. The peak incidence rate is between the age of 10 years and 13 years old (total range: one day to 18 years), with a 1.3-1.7:1 male-to-female ratio.
Proximal femur fracture in pediatrics accounts for 1.2 to two cases per year, which is considered 0.3-0.5% of fractures in children. Non-road traffic accidents were the cause of 93% of all cases. The male-to-female ratio was 2.3:1, and the risk of injury appeared to be higher in preschool children (two to six years) than in adolescents (12-14 years). The result showed that the most commonly stumble-on fractures were the forearm (39.6%), humerus (12%), clavicle (11%), tibia and fibula (10.6%), and femur (5.6%). In Saudi Arabia, a study of 1456 diagnosed cases of accidental fractures and dislocations in children was carried out to assess the patterns of fractures and dislocations. It is also associated with a risk of possible long-term dysfunction and adverse complications. Pediatric femoral neck fractures are rare, frequently caused by a high mechanism of injury, and commonly combined with multiple trauma.
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