Delayed fixation of the transcervical fracture of the neck of the femur in the pediatric population: results and complications

Purpose To determine the impact of a substantial delay in providing surgical treatment on the final outcome in transcervical femoral neck fractures in children. Methods Data on all pediatric patients with transcervical fractures of the femoral neck that were fixed by reduction and internal fixation after a delay of >= 7 days in our department between 2000 and 2008 were collected both retrospectively and prospectively. Results The medical records of 14 patients (15 fractures) were analyzed. The results after an average of 43 months of follow-up showed that the complication and avascular necrosis rates were higher in cases in which treatment had been delayed compared to those in comparable fractures that had been treated promptly after the event in other series. Nine of the 15 fractures had developed avascular necrosis at final follow-up. Overall, there were four excellent, three good, and eight poor results (based on the Ratliff criteria). Conclusions Children whose transcervical fractures of the femoral neck were surgically treated after a delay of 1 week or longer had a high avascular necrosis rate and a relatively poor outcome. Reduction and internal fixation as the initial treatment should be implemented shortly after injury in order to enhance treatment outcome.