Revista Brasileira de Ortopedia
Print version ISSN 0102-3616
ASTUR, Diego da Costa et al. Correlation between avascular necrosis and early stabilization of proximal femoral fractures in childhood. Rev. bras. ortop. [online]. 2010, vol.45, n.4, pp. 426-432. ISSN 0102-3616. http://dx.doi.org/10.1590/S0102-36162010000400015.
OBJETIVE: This study was developed with the main purpose of evaluating treatment results of proximal femoral fractures in a series of cases. We sought to observe the influence of the most frequent complications on the final results after a minimum follow-up of 2 years. We have especially considered the relationship between development of avascular necrosis and time between the accident and therapeutic intervention. METHOD: We retrospectively studied proximal femoral fractures in 29 patients under 14 years of age from 1988 to 2007. The following parameters were analyzed: sex, age, mechanism of injury, fracture classification (Delbet), treatment, complications (pseudoarthrosis, coxa vara, leg length discrepancy and avascular necrosis), time for surgery, and results (Ratliff). Statistical analysis was performed according to the descriptive evaluation of each parameter by using Fisher's exact test. RESULTS: Five (17.2%) patients had avascular necrosis, 3 of whom (60.0%) were older than 10 years of age. Seventy-three point three percent of patients treated in the first 24 hours showed good results. The most common cause of fracture was traffic accident (44.8%). The best results were observed in patients who were treated surgically; 41.4% developed some type of complication. CONCLUSIONS: Among the 29 patients treated, 58.6% had good, 27.6% had regular and 13.8% had poor results according to Ratliff criteria. When conservative treatment was applied, only 17.0% had good results, while surgical intervention results were 69.3% good. In addition, we obtained 73.3% good results when surgery was performed within the first 24 hours and only 42.8% good results in patients submitted to surgery after this period. Patients operated in the first 24 hours developed avascular necrosis in 13.3% of cases, while 21.4% of those operated after that period developed this complication.
Keywords : Femoral fractures [epidemiology]; Femoral fractures [surgery]; Child.