Progress of hip fracture treatment in children_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Hai , LIU Yang ,  LIU Lei

Department of Othopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

LIU Lei, Email: liuinsistence@163.com

Keywords：

Hip fracture; child; surgical treatment; complication

DOI：

10.7507/1002-1892.201907005

Video：

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Objective To review the progress of hip fracture treatment in children.Methods Literature about the hip fracture treatment in children was extensively reviewed and summarized in terms of anatomy and blood supply, fracture classification, surgical treatment principles, and complications.Results The anatomical structure of children’s hips and the characteristics of peripheral blood supply constantly change with age. Delbet classification is the most classic classification of hip fracture in children. Children’s age and Delbet classification have significant effects on surgical treatment strategies and post-fracture complications. The timing of surgical treatment, accurate anatomical reduction, and appropriate internal fixation can effectively improve the prognosis and reduce the incidence of complications. Common complications include osteonecrosis of the femoral head, coxa vara, premature physeal closure, and nonunion. Conclusion There are still some controversies on the treatment concept and internal fixation choice for children’s hip fracture. So it is necessary to further study the anatomy and blood supply characteristics of children’s hip, improve the selection and application skills of internal fixation devices, so as to avoid serious complications.

Citation： YANG Hai, LIU Yang, LIU Lei. Progress of hip fracture treatment in children. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(3): 404-408. doi: 10.7507/1002-1892.201907005 Copy

1.	Ratliff AH. Fractures of the neck of the femur in children. J Bone Joint Surg (Br), 1962, 44-B: 528-542.
2.	Togrul E, Bayram H, Gulsen M, et al. Fractures of the femoral neck in children: long-term follow-up in 62 hip fractures. Injury, 2005, 36(1): 123-130.
3.	Dendane MA, Amrani A, El Alami ZF, et al. Displaced femoral neck fractures in children: are complications predictable? Orthop Traumatol Surg Res, 2010, 96(2): 161-165.
4.	Yeranosian M, Horneff JG, Baldwin K, et al. Factors affecting the outcome of fractures of the femoral neck in children and adolescents: a systematic review. Bone Joint J, 2013, 95-B(1): 135-142.
5.	Shrader MW, Jacofsky DJ, Stans AA, et al. Femoral neck fractures in pediatric patients: 30 years experience at a level 1 trauma center. Clin Orthop Relat Res, 2007, 454: 169-173.
6.	Mirdad T. Fractures of the neck of femur in children: an experience at the Aseer Central Hospital, Abha, Saudi Arabia. Injury, 2002, 33(9): 823-827.
7.	Beaty JH. Fractures of the hip in children. Orthop Clin North Am, 2006, 37(2): 223-232.
8.	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.
9.	Chung SM. The arterial supply of the developing proximal end of the human femur. J Bone Joint Surg (Am), 1976, 58(7): 961-970.
10.	Ogden JA. Changing patterns of proximal femoral vascularity. J Bone Joint Surg (Am), 1974, 56(5): 941-950.
11.	Trueta J. The normal vascular anatomy of the human femoral head during growth. J Bone Joint Surg (Br), 1957, 39-B(2): 358-394.
12.	Johnson EO, Soultanis K, Soucacos PN. Vascular anatomy and microcirculation of skeletal zones vulnerable to osteonecrosis: vascularization of the femoral head. Orthop Clin North Am, 2004, 35(3): 285-291.
13.	Palocaren T. Femoral neck fractures in children: a review. Indian J Orthop, 2018, 52(5): 501-506.
14.	Colonna PC. Fracture of the neck of the femur of the childhood: a report of six cases. Ann Surg, 1928, 88(5): 902-907.
15.	Dial BL, Lark RK. Pediatric proximal femur fractures. J Orthop, 2018, 15(2): 529-535.
16.	Spence D, DiMauro JP, Miller PE, et al. Osteonecrosis after femoral neck fractures in children and adolescents: analysis of risk factors. J Pediatr Orthop, 2016, 36(2): 111-116.
17.	Papalia R, Torre G, Maffulli N, et al. Hip fractures in children and adolescents. Br Med Bull, 2019, 129(1): 117-128.
18.	Patterson JT, Tangtiphaiboontana J, Pandya NK. Management of pediatric femoral neck fracture. J Am Acad Orthop Surg, 2018, 26(12): 411-419.
19.	AlKhatib N, Younis MH, Hegazy A, et al. Early versus late treatment of paediatric femoral neck fractures: a systematic review and meta-analysis. Int Orthop, 2019, 43(3): 677-685.
20.	孟祥栋, 张宗武. 手术与非手术治疗儿童股骨颈骨折的疗效比较. 中国骨与关节损伤杂志, 2018, 33(5): 538-539.
21.	Iwata T, Nozawa S, Dohjima T, et al. The value of T1-weighted coronal MRI scans in diagnosing occult fracture of the hip. J Bone Joint Surg (Br), 2012, 94(7): 969-973.
22.	Foex BA, Russell A. BET 2: CT versus MRI for occult hip fractures. Emerg Med J, 2018, 35(10): 645-647.
23.	岳海源. 术前牵引与未牵引治疗髋部骨折的系统评价. 兰州: 兰州大学, 2010.
24.	魏志辉, 张铭华, 张中卒, 等. 髋部骨折术前皮肤牵引治疗的系统评价. 中国组织工程研究, 2019, 23(16): 2594-2600.
25.	李海波, 许圣茜, 汤雪霞, 等. 术前牵引对股骨颈骨折术后发生股骨头缺血性坏死的影响研究. 中国修复重建外科杂志, 2019, 33(6): 671-675.
26.	Leer-Salvesen S, Engesaeter LB, Dybvik E, et al. Does time from fracture to surgery affect mortality and intraoperative medical complications for hip fracture patients? An observational study of 73 557 patients reported to the Norwegian Hip Fracture Register. Bone Joint J, 2019, 101-B(9): 1129-1137.
27.	Moran CG, Wenn RT, Sikand M, et al. Early mortality after hip fracture: Is delay before surgery important? J Bone Joint Surg (Am), 2005, 87(3): 483-489.
28.	Bombaci H, Centel T, Babay A, et al. Evaluation of complications of femoral neck fractures in children operated on at least 24 hours after initial trauma. Acta Orthop Traumatol Turc, 2006, 40(1): 6-14.
29.	Riley PM Jr, Morscher MA, Gothard MD, et al. Earlier time to reduction did not reduce rates of femoral head osteonecrosis in pediatric hip fractures. J Orthop Trauma, 2015, 29(5): 231-238.
30.	Bukva B, Abramović D, Vrgoč G, et al. Femoral neck fractures in children and the role of early hip decompression in final outcome. Injury, 2015, 46(Suppl 6): S44-S47.
31.	Ju L, Jiang B, Lou Y, et al. Delayed treatment of femoral neck fractures in 58 children: open reduction internal fixation versus closed reduction internal fixation. J Pediatr Orthop B, 2016, 25(5): 459-465.
32.	Boardman MJ, Herman MJ, Buck B, et al. Hip fractures in children. J Am Acad Orthop Surg, 2009, 17(3): 162-173.
33.	Stone JD, Hill MK, Pan Z, et al. Open reduction of pediatric femoral neck fractures reduces osteonecrosis risk. Orthopedics, 2015, 38(11): e983-e990.
34.	Song KS. Displaced fracture of the femoral neck in children: open versus closed reduction. J Bone Joint Surg (Br), 2010, 92(8): 1148-1151.
35.	Ghayoumi P, Kandemir U, Morshed S. Evidence based update: open versus closed reduction. Injury, 2015, 46(3): 467-473.
36.	Slobogean GP, Sprague SA, Scott T, et al. Complications following young femoral neck fractures. Injury, 2015, 46(3): 484-491.
37.	Prentice HA, Paxton EW, Hunt JJ, et al. Pediatric hip fractures in california: results from a community-based hip fracture registry. Perm J, 2017, 21: 16-81.
38.	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.
39.	Canale ST. Traumatic dislocations and fracture-dislocations of the hip in children. Hip, 1981: 219-245.
40.	Ingram AJ, Bachynski B. Fractures of the hip in children; treatment and results. J Bone Joint Surg (Am), 1953, 35-A(4): 867-887.
41.	Juréus J, Geijer M, Tiderius CJ, et al. Vascular evaluation after cervical hip fractures in children: a case series of eight children examined by scintigraphy after surgery for cervical hip fracture and evaluated for development of secondary radiological changes. J Pediatr Orthop B, 2016, 25(1): 17-23.
42.	Eamsobhana P, Keawpornsawan K. Nonunion paediatric femoral neck fracture treatment without open reduction. Hip Int, 2016, 26(6): 608-611.
43.	Magu NK, Singh R, Sharma AK, et al. Modified Pauwels’ intertrochanteric osteotomy in neglected femoral neck fractures in children: a report of 10 cases followed for a minimum of 5 years. J Orthop Trauma, 2007, 21(4): 237-243.
44.	Lurie B, Koff MF, Shah P, et al. Three-dimensional magnetic resonance imaging of physeal injury: reliability and clinical utility. J Pediatr Orthop, 2014, 34(3): 239-245.
45.	Canale ST, Bourland WL. Fracture of the neck and intertrochanteric region of the femur in children. J Bone Joint Surg (Am), 1977, 59(4): 431-443.
46.	Lam SF. Fractures of the neck of the femur in children. J Bone Joint Surg (Am), 1971, 53(6): 1165-1179.

1. Ratliff AH. Fractures of the neck of the femur in children. J Bone Joint Surg (Br), 1962, 44-B: 528-542.
2. Togrul E, Bayram H, Gulsen M, et al. Fractures of the femoral neck in children: long-term follow-up in 62 hip fractures. Injury, 2005, 36(1): 123-130.
3. Dendane MA, Amrani A, El Alami ZF, et al. Displaced femoral neck fractures in children: are complications predictable? Orthop Traumatol Surg Res, 2010, 96(2): 161-165.
4. Yeranosian M, Horneff JG, Baldwin K, et al. Factors affecting the outcome of fractures of the femoral neck in children and adolescents: a systematic review. Bone Joint J, 2013, 95-B(1): 135-142.
5. Shrader MW, Jacofsky DJ, Stans AA, et al. Femoral neck fractures in pediatric patients: 30 years experience at a level 1 trauma center. Clin Orthop Relat Res, 2007, 454: 169-173.
6. Mirdad T. Fractures of the neck of femur in children: an experience at the Aseer Central Hospital, Abha, Saudi Arabia. Injury, 2002, 33(9): 823-827.
7. Beaty JH. Fractures of the hip in children. Orthop Clin North Am, 2006, 37(2): 223-232.
8. 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.
9. Chung SM. The arterial supply of the developing proximal end of the human femur. J Bone Joint Surg (Am), 1976, 58(7): 961-970.
10. Ogden JA. Changing patterns of proximal femoral vascularity. J Bone Joint Surg (Am), 1974, 56(5): 941-950.
11. Trueta J. The normal vascular anatomy of the human femoral head during growth. J Bone Joint Surg (Br), 1957, 39-B(2): 358-394.
12. Johnson EO, Soultanis K, Soucacos PN. Vascular anatomy and microcirculation of skeletal zones vulnerable to osteonecrosis: vascularization of the femoral head. Orthop Clin North Am, 2004, 35(3): 285-291.
13. Palocaren T. Femoral neck fractures in children: a review. Indian J Orthop, 2018, 52(5): 501-506.
14. Colonna PC. Fracture of the neck of the femur of the childhood: a report of six cases. Ann Surg, 1928, 88(5): 902-907.
15. Dial BL, Lark RK. Pediatric proximal femur fractures. J Orthop, 2018, 15(2): 529-535.
16. Spence D, DiMauro JP, Miller PE, et al. Osteonecrosis after femoral neck fractures in children and adolescents: analysis of risk factors. J Pediatr Orthop, 2016, 36(2): 111-116.
17. Papalia R, Torre G, Maffulli N, et al. Hip fractures in children and adolescents. Br Med Bull, 2019, 129(1): 117-128.
18. Patterson JT, Tangtiphaiboontana J, Pandya NK. Management of pediatric femoral neck fracture. J Am Acad Orthop Surg, 2018, 26(12): 411-419.
19. AlKhatib N, Younis MH, Hegazy A, et al. Early versus late treatment of paediatric femoral neck fractures: a systematic review and meta-analysis. Int Orthop, 2019, 43(3): 677-685.
20. 孟祥栋, 张宗武. 手术与非手术治疗儿童股骨颈骨折的疗效比较. 中国骨与关节损伤杂志, 2018, 33(5): 538-539.
21. Iwata T, Nozawa S, Dohjima T, et al. The value of T1-weighted coronal MRI scans in diagnosing occult fracture of the hip. J Bone Joint Surg (Br), 2012, 94(7): 969-973.
22. Foex BA, Russell A. BET 2: CT versus MRI for occult hip fractures. Emerg Med J, 2018, 35(10): 645-647.
23. 岳海源. 术前牵引与未牵引治疗髋部骨折的系统评价. 兰州: 兰州大学, 2010.
24. 魏志辉, 张铭华, 张中卒, 等. 髋部骨折术前皮肤牵引治疗的系统评价. 中国组织工程研究, 2019, 23(16): 2594-2600.
25. 李海波, 许圣茜, 汤雪霞, 等. 术前牵引对股骨颈骨折术后发生股骨头缺血性坏死的影响研究. 中国修复重建外科杂志, 2019, 33(6): 671-675.
26. Leer-Salvesen S, Engesaeter LB, Dybvik E, et al. Does time from fracture to surgery affect mortality and intraoperative medical complications for hip fracture patients? An observational study of 73 557 patients reported to the Norwegian Hip Fracture Register. Bone Joint J, 2019, 101-B(9): 1129-1137.
27. Moran CG, Wenn RT, Sikand M, et al. Early mortality after hip fracture: Is delay before surgery important? J Bone Joint Surg (Am), 2005, 87(3): 483-489.
28. Bombaci H, Centel T, Babay A, et al. Evaluation of complications of femoral neck fractures in children operated on at least 24 hours after initial trauma. Acta Orthop Traumatol Turc, 2006, 40(1): 6-14.
29. Riley PM Jr, Morscher MA, Gothard MD, et al. Earlier time to reduction did not reduce rates of femoral head osteonecrosis in pediatric hip fractures. J Orthop Trauma, 2015, 29(5): 231-238.
30. Bukva B, Abramović D, Vrgoč G, et al. Femoral neck fractures in children and the role of early hip decompression in final outcome. Injury, 2015, 46(Suppl 6): S44-S47.
31. Ju L, Jiang B, Lou Y, et al. Delayed treatment of femoral neck fractures in 58 children: open reduction internal fixation versus closed reduction internal fixation. J Pediatr Orthop B, 2016, 25(5): 459-465.
32. Boardman MJ, Herman MJ, Buck B, et al. Hip fractures in children. J Am Acad Orthop Surg, 2009, 17(3): 162-173.
33. Stone JD, Hill MK, Pan Z, et al. Open reduction of pediatric femoral neck fractures reduces osteonecrosis risk. Orthopedics, 2015, 38(11): e983-e990.
34. Song KS. Displaced fracture of the femoral neck in children: open versus closed reduction. J Bone Joint Surg (Br), 2010, 92(8): 1148-1151.
35. Ghayoumi P, Kandemir U, Morshed S. Evidence based update: open versus closed reduction. Injury, 2015, 46(3): 467-473.
36. Slobogean GP, Sprague SA, Scott T, et al. Complications following young femoral neck fractures. Injury, 2015, 46(3): 484-491.
37. Prentice HA, Paxton EW, Hunt JJ, et al. Pediatric hip fractures in california: results from a community-based hip fracture registry. Perm J, 2017, 21: 16-81.
38. 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.
39. Canale ST. Traumatic dislocations and fracture-dislocations of the hip in children. Hip, 1981: 219-245.
40. Ingram AJ, Bachynski B. Fractures of the hip in children; treatment and results. J Bone Joint Surg (Am), 1953, 35-A(4): 867-887.
41. Juréus J, Geijer M, Tiderius CJ, et al. Vascular evaluation after cervical hip fractures in children: a case series of eight children examined by scintigraphy after surgery for cervical hip fracture and evaluated for development of secondary radiological changes. J Pediatr Orthop B, 2016, 25(1): 17-23.
42. Eamsobhana P, Keawpornsawan K. Nonunion paediatric femoral neck fracture treatment without open reduction. Hip Int, 2016, 26(6): 608-611.
43. Magu NK, Singh R, Sharma AK, et al. Modified Pauwels’ intertrochanteric osteotomy in neglected femoral neck fractures in children: a report of 10 cases followed for a minimum of 5 years. J Orthop Trauma, 2007, 21(4): 237-243.
44. Lurie B, Koff MF, Shah P, et al. Three-dimensional magnetic resonance imaging of physeal injury: reliability and clinical utility. J Pediatr Orthop, 2014, 34(3): 239-245.
45. Canale ST, Bourland WL. Fracture of the neck and intertrochanteric region of the femur in children. J Bone Joint Surg (Am), 1977, 59(4): 431-443.
46. Lam SF. Fractures of the neck of the femur in children. J Bone Joint Surg (Am), 1971, 53(6): 1165-1179.

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