Delayed treatment of femoral neck fractures in 58 children: open reduction internal fixation versus closed reduction internal fixation.

UNLABELLED: The best treatment plan for femoral neck fractures in children in whom treatment is delayed by more than 24 h is unclear because of the limited number of such cases reported. This study compares the outcomes of closed and open reduction performed 24 h after the injury was sustained. We retrospectively reviewed 58 cases (40 males, 18 females) of femoral neck fractures reset after more than a 24-h delay at our hospital (May 2005 to May 2014). According to Delbet's classification, there were 30 type II fractures (51.7%), 21 type III fractures (36.2%), and seven type IV fractures (12.1%). A total of 21 patients underwent closed reduction and internal fixation; the remaining patients underwent open reduction and internal fixation. The follow-up period was 17-61 months (average, 35.1 months). The results were classified according to Ratliff's criteria. With the exception of one case of bone nonunion (closed reduction group), the fracture was healed in the remaining cases. The average healing time was 10.82 weeks (9-13 weeks). The incidence of avascular necrosis was significantly lower in the open reduction group. Further, the percentage of results classified as 'fine' according to Ratliff's criteria was significantly higher in the open reduction group than in the closed reduction group. Coxa vara occurred in three patients in the closed reduction group, but it did not occur in any of the patients in the open reduction group. The incidence of avascular necrosis was significantly lower in the patients who achieved anatomical reduction than in the patients who only achieved acceptable reduction. Finally, the results in the anatomical reduction group were obviously better than those in the acceptable reduction group. Open reduction with internal fixation yielded better outcomes than closed reduction in this group of children with displaced femoral neck fractures who were treated more than 24 h after the injury. This may be related to the better reduction quality in the open reduction group.

LEVEL OF EVIDENCE: Therapeutic studies: investigating the results of treatment, Level III.