Introduction: The aim of this study was to review the cases of pediatric fracture neck of femur (FNOF) in Hong Kong SAR, Southern China, from 1998 to 2017 and to study the experience in our locality and find out any specific pattern and any preventive measures to reduce this type of injury.
Materials and methods: Seventy-two teenagers who suffered from FNOF were recruited. Demographic characteristics, radiological and functional outcomes, and trauma levels were collected and analyzed.
Results: Mean age at injury was 12.42 years. Garden\'s classification was found in four cases (50%). The number of patients admitted in summer was significantly higher than during winter (57.1% vs 42.9%, p = 0.04).
Conclusion: There was a higher incidence of FNOF in summer compared to winter. There was a change in major trauma incidence from high-energy to low-energy trauma over the 20 years. Patients with low-energy injury stayed shorter period in the hospital than those who sustained high-energy injury.
Key messages1. Majority of the patients who sustained FNOF are older children (>10 years old), and most were boys.2. There is a seasonal pattern for the injury where summer is slightly predominant.3. There is a changing dominance in injury mechanism from majority of high-energy to low-energy trauma over the 20 years.
Ratliff AH. Fractures of the neck of the femur in children. J Bone Joint Surg Br 1962;44(3):528–542. DOI: 10.1302/0301-620X.44B3.528.
Canale ST. Fractures of the hip in children and adolescents. Orthop Clin North America 1990;21(2):341–352.
Canale ST, Bourland WL. Fracture of the neck andintertrochanteric region of the femur in children. J Bone Joint Surg Am 1977;59(4): 431–443. DOI: 10.2106/00004623-197759040-00001.
Hughes LO, Beaty JH. Fractures of the head and neck of the femur in children. J Bone Joint Surg Am 1994;76(2):283–292. DOI: 10.2106/00004623-199402000-00019.
Kuo F-C, Kuo S-J, Ko J-Y, et al. Complications of hip fractures in children. Chang Gung Med J 2011;34(5):512–519.
Ratliff AHC. Complications after fractures of the femoral neck in children and their treatment. J Bone Joint Surg 1970;52-B:175.
Bagatur AE, Zorer G. Complications associated with surgically treated hip fractures in children. J Pediatr Orthop B 2002;11(3):219–228. DOI: 10.1097/01202412-200207000-00005.
Colonna PC. Fractures of the neck of the femur in children. Am J Surg 1929;6(6):793–797. DOI: 10.1016/S0002-9610(29)90726-1.
Forlin E, Guille JT, Kumar SJ, et al. Complications associated with fracture of the neck of femur in children. J Pediatr Orthop 1992;12(4):503–509. DOI: 10.1097/01241398-199207000-00017.
Kay SP, Hall JE. Fracture of the femoral in children and its complications. Clin Orthop 1971;80:53–71. DOI: 10.1097/00003086-197110000-00009.
Quick TJ, Eastwood DM. Pediatric fractures and dislocations of the hip and pelvis. Clin Orthop Relat Res 2005;432(432):87–96. DOI: 10.1097/01.blo.0000155372.65446.40.
Kamal Bali MS, Pebam Sudesh MS, Sandeep Patel MS, et al. MS. pediatric femoral neck fractures: our 10 years of experience. Clin Orthop Surg 2011;3:302–308.
Mirdad T. Fractures of the neck of the femur in children: an experience at the Aseer central hospital, Abha, Saudi Arabia. Injury 2002;33(9):823–827. DOI: 10.1016/s0020-1383(02)00013-x.
Cheng JC, Tang N. Decompression and stable internal fixation of femoral neck fractures in children can affect the outcome. J Pediatr Orthop 1999;19(3):338–343. DOI: 10.1097/01241398-199905000-00010.
Patterson JT, Tangtiphaiboontana J, Pandya NK. Management of pediatric femoral neck fracture. J Am Acad Orthop Surg 2018;26(12):411–419. DOI: 10.5435/JAAOS-D-16-00362.
Muschitz C, Kocijan R, Baierl A, et al. Preceding and subsequent high- and low-trauma fracture patterns-a 13-year epidemiological study in females and males in Austria. Osteoporos Int 2017;28(5):1609–1618. DOI: 10.1007/s00198-017-3925-3.
Caldwell L, Chan CM, Sanders JO, et al. Detection of femoral neck fractures in pediatric patients with femoral shaft fractures. J Pediatr Orthop 2017;37(3):e164–e167. DOI: 10.1097/BPO.0000000000000800.
Moon ES, Mehlman CT. Risk factors for avascular necrosis after femoral neck fractures in children: 25 cincinnati cases and Meta-analysis of 360 cases. J Orthop Trauma 2006;20(5):323–329. DOI: 10.1097/00005131-200605000-00005.
Pforringer W, Rosemeyer B. Fractures of the hip in children and adolescents. Acta Orthop Scand 1980;51(1-6):91–108. DOI: 10.3109/17453678008990774.
Swiontkowski MF, Winquist RA. Displaced hip fractures in children and adolescents. J Trauma 1986;26(4):384–388. DOI: 10.1097/00005373-198604000-00013.
Morsy HA. Complications of fracture of the neck in the femur in children: A long-term follow-up study. Injury 2001;32(1):45–51. DOI: 10.1016/s0020-1383(00)00109-1.
Landin LA. Fracture patterns in children. analysis of 8,682 fractures with special reference to incidence, etiology and secular changes in a swedish urban population 1950–1979. Acta Orthop Scand Suppl 1983;202:1–109.
Segal D, Slevin O, Aliev E, et al. Trends in the seasonal variation of paediatric fractures. J Child Orthop 2018;12(6):614–621. DOI: 10.1302/1863-2548.12.180114.
Key LL Jr, Ries W, Madyastha P, et al. Juvenile osteoporosis: recognizing the risk. J Pediatr Endocrinol Metab 2003;16(Suppl 3):683–686.