10 / 99
F
emoral
neck
fracture
in
children
:
treatment
and
complications
R
ev
A
ssoc
M
ed
B
ras
2015; 61(1):5-7
5
GUIDELINES IN FOCUS
Femoral neck fracture in children: treatment and complications
F
ratura
do
cólo
do
fêmur
em
crianças
:
tratamento
e
complicações
Authorship:
Brazilian Society of Orthopedics and Traumatology
Participants:
Akkari M, Santili C, Akel E, Angelim R
http://dx.doi.org/10.1590/1806-9282.61.01.005The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standar-
dize procedures to assist the reasoning and decision-making of doctors.
The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, de-
pending on the conditions and the clinical status of each patient.
D
escription
of
the
evidence
colection
method
Searches were conducted in the Medline database. The
MeSH (Medical Subject Heading Terms) key-words used
for the search were: “femoral neck”, “fractures/surgery”,
“child”, “femoral neck fracture/complications”, “decom-
pression surgical”, “internal fixation”. Thus, questions
related to the topic were developed with a focus on the
following aspects: types of treatment; best time to thera-
peutic approach; and ideal treatment with lower compli-
cation rates. Based on this, the questions were structured
using PICO (pacient, intervention, comparison, outco-
me) methodology, and the search began with the selec-
tion of papers with better strength of scientific evidence.
D
egree
of
evidence
recommendation
A. Experimental or observational studies of higher con-
sistency.
B. Experimental or observational studies of lower con-
sistency.
C. Case reports (non-controlled studies).
D. Opinions without critical evaluation, based on con-
sensus, physiological studies, or animal models.
O
bjective
To develop a guideline for the treatment of femoral neck
fracture in children, which can help orthopedists to ma-
nage rapidly and accurately this type of fractures aiming
at correct treatment and fewer complications based on
the best available scientific evidence.
C
onflict
of
interest
No conflict of interest informed.
I
ntroduction
Proximal femoral fractures in children are relatively rare
events, accounting for about 1% of all fractures in chil-
dhood. Trauma mechanisms derive mostly from high-
-energy trauma (80 to 90%) and less frequently from low-
-energy trauma or disease states.
1
Classification is based
on the location of the fracture line, being the most used
for this type of fracture the Delbet system (1907), later
popularized by Colonna (1929), which divides fractures
in types I, II, III and IV, which may assist in treatment de-
cision-making, in addition to being a predictor of risk for
complications.
2
Major complications occur especially due
to interference with local growth, and due to vasculari-
zation and consolidation disorders.
2
These complications
include avascular necrosis (AVN), pseudoarthrosis,
coxa
vara
and limb shortening. The subject is important due
to the fact that these are serious fractures, both in terms
of trauma mechanism involved and frequent complica-
tions and disabling
sequelae
. Therefore, it is an orthope-
dic emergency that requires a fast and accurate strategy
in order to reduce complications to a minimum, and thus
the costs associated with treatment and rehabilitation of
these patients.
1,2
W
hich
are
the
most
relevant
risk
factors
for
the
development
of
avascular
necrosis
after
femoral
neck
fractures
?
Among the complications associated with femoral neck
fractures in children, avascular necrosis (AVN) is the most
worrying. It is important to identify predictive risk factors
for AVN in this type of trauma. Type of fracture, the
patient’s age, occurrence of deviation and the quality of re-
duction are all indicators for risk of AVN (
A
,
B
).
3,4
Regar-
ding the type of fracture, type IV fractures have a lower in-
cidence of AVN compared with the other types. Compared
to type IV fractures according to Delbet’s classification,
fracture types I, II and III show respectively 14.5, 6.5 and
3.7 higher chances of developing AVN. Regarding age, it
has been noticed that it is directly proportional to the risk
of AVN, and the risk rises to a ratio of 1:14 for each year of