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Time to definitive surgical procedure has no effect on outcome
2%
121/4886
Open reduction with capsular decompression is contraindicated
82/4886
Internal fixation with a cephalomedullary nail leads to higher union rates than screw fixation
7%
323/4886
Nonunion is the most common complication if surgical intervention is performed
13%
639/4886
Closed reduction and cannulated screw fixation across the physis is an acceptable form of surgical management
75%
3667/4886
Select Answer to see Preferred Response
Figure A shows a displaced, transcervical fracture of the femoral neck. Transphyseal screw fixation provides the most reliable fracture stability and is recommended for treatment of most children’s hip fractures (age >6) despite the secondary effect of premature physeal closure. Femoral neck fractures in children are a rare occurrence with potentially devastating complications. Delbet classifies pediatric femoral neck fractures as follows: type 1) transphyseal, type 2) transcervical, type 3) basicervical, and type 4) intertrochanteric. Treatment for type 2 fractures includes cannulated screw fixation with or without a capsular decompression. The benefits of capsular decompression remain controversial, with some arguing decreased rates of AVN if performed. Song et al. reviewed 27 femoral neck fractures in children younger than 16. 15 were treated with open reduction and internal fixation (including capsulotomy and reduction under direct visualization) and 12 were treated with closed reduction and internal fixation (CRIF). When compared to CRIF, ORIF provided a more anatomic reduction and a decreased rate of avascular necrosis. Hajdu et al. reviewed the results of 8 children (age <16) with proximal femur fractures treated surgically. 5 of the 8 had an acute slipped capital femoral epiphysis, 2 had a basicervical femoral neck fracture, and 1 had an intertrochanteric fracture. One of the patients who had an acute slipped capital femoral epiphysis developed AVN, and it was the only patient in the series operated on 48 hours after the injury. They stress the importance of early surgical fixation. Illustration A shows the Delbet classification of femoral head/neck fractures in children. Incorrect Answers: Answer 1: Surgical treatment within 48 hours has been shown to decrease rates of osteonecrosis. Answer 2: Capsular decompression is not contraindicated, and is favored by some surgeons. Answer 3: Internal fixation with cannulated screws is the preferred method of treatment. Answer 4: Osteonecrosis is the most common complication following surgical fixation.
2.5
(30)
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