Displaced fracture of the femoral neck in children OPEN VERSUS CLOSED REDUCTION

Abstract

We have investigated whether early anatomical open reduction and internal fixation (ORIF) reduces the incidence of complications of fracture of the femoral neck in children, including avascular necrosis, compared with closed reduction and internal fixation (CRIF). We retrospectively reviewed 27 such fractures (15 ty pe-II and 12 type-III di splaced fractures) in children younger than 16 years of age seen in our hospital between February 1989 and March 2007. We divided the patients into three groups according to the quality of the reduction (anatomical, acceptab le, and unacceptable) and the clinical results into two groups (satisfactory and unsatisfactory). Of th e 15 fractures treated by ORIF, 14 (93.3%) had anatomical reduction and reduction was acceptable in one. Of the 12 treated by CRIF, three (25.0%) had anatomical reductio n, eight had acceptable reduction (66.7%), and one (8.3%) unacceptable reduction. Of th e 15 fractures treated by ORIF, 14 (93.3%) had a good result and one a fair result. Of the 12 treated by CRI F, seven (58.3%) had a good result, two (16.7%) a fair result and three (25.0%) a poor result. Th ere were seven complicati ons in five patients. ORIF gives better reduction with fewer comp lications, including avascular necrosis, than does CRIF in fractures of the femoral neck in children