Skip to main content
Log in

Types and complications of femoral neck fractures in children

  • Originals
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

This multicenter collaborative study was undertaken to review the types and complications of femoral neck fractures in children. It is a retrospective clinical and radiological review of 108 femoral neck fractures. Cases originated from four different pediatric hospitals. All the patients had plain radiographs. Fractures occurred at all ages (one day to 18 years), and 63% of the patients were boys. Forty-nine fractures were traumatic; 37 were pathologic, 19 were insufficiency fractures; and three were fatique fractures. Unless the underlying bone was abnormal, significant high velocity trauma, fall from a height or other severe violence was required to fracture the femoral neck. A unicameral bone cyst was the underlying lesion in 40% of pathologic femoral neck fractures and malignancy in 35%. Osteoporosis as in myelodysplasia, osteogenesis imperfecta and from other causes was responsible for 52% of insufficiency fractures. Because of the unique osseous and vascular anatomy of the femoral head and neck in the growing child, these fractures have a high incidence of complications. Complications included avascular necrosis 13%, premature closure of the epiphyseal plate 12%, varus deformity 8.3%, and nonunion 3.7%. Unless there is a clear history of significant violence, a cause for a femoral neck fracture should be sought, e. g. an underlying bone lesion or a metabolic bone disease. These fractures are rare, but are serious injuries since their complications may lead to a life-long disability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Colonna PC (1929) Fractures of the neck of the femur in children. Am J Surg 6:793–797

    Article  Google Scholar 

  2. Morrissy R (1980) Hip fractures in children. Clin Orthop 152: 202–210

    PubMed  Google Scholar 

  3. Swiontkowski MF, Winquist RA (1986) Displaced hip fractures in children and adolescents. J Trauma 26:384–388

    PubMed  Google Scholar 

  4. Chung SMK (1981) Hip disorders in infants and children. Lea & Febiger. Philadelphia, pp 339–346

    Google Scholar 

  5. Barquet A (1987) Traumatic hip dislocation in childhood. Springer, Berlin, pp 14–16

    Google Scholar 

  6. Barquet A, Vécsei V (1984) Traumatic dislocation of the hip with separation of the proximal femoral epiphysis. Arch Orthop Trauma Surg 103:219–223

    Article  PubMed  Google Scholar 

  7. Lam SF (1971) Fractures of the neck of the femur in children. J Bone Joint Surg [Am] 53:1165–1179

    Google Scholar 

  8. Canale ST, Bourland WL (1977) Fracture of the neck and intertrochanteric region of the femur in children. J Bone Joint Surg [Am] 59:431–443

    Google Scholar 

  9. Ovesen O, Arreskov J, Bellstrøm T (1989) Hip fractures in children. A long-term follow-up of 17 cases. Orthopedics 12:361–367

    PubMed  Google Scholar 

  10. Azouz EM (1983) Apparent or true neonatal hip dislocation? Radiologic differential diagnosis. Can Med Assoc J 129:595–597

    PubMed  Google Scholar 

  11. Crawford AH (1988) Slipped capital femoral epiphysis. J Bone Joint Surg [Am] 70:1422–1427

    Google Scholar 

  12. Davison BL, Weinstein SL (1992) Hip fractures in children: a long-term follow-up study. J Pediatr Orthop 12:355–358

    PubMed  Google Scholar 

  13. Azouz EM (1992) Tumors. In: Reed MH (ed) Pediatric skeletal radiology. Williams & Wilkins, Baltimore, pp 530–532

    Google Scholar 

  14. Vieco PT, Azouz EM, Hoeffel JC (1989) Metastases to bone in medulloblastoma. Skeletal Radiol 18:445–449

    Article  PubMed  Google Scholar 

  15. Boytim MJ, Davidson RS, Charney E, Melchionni JB (1991) Neonatal fractures in myelomeningocele patients. J Pediatr Orthop 11:28–30

    PubMed  Google Scholar 

  16. Michel F, Bérard J, Michel CR (1988) Les décollements épiphysaires spontanés chez l'enfant porteur d'un spina bifida. Chir Pédiatr 29:29–35

    Google Scholar 

  17. Westcott MA, Dynes MC, Remer EM, Donaldson JS, Dias LS (1992) Congenital and acquired orthopedic abnormalities in patients with myelomeningocele. Radiographics 12:1155–1172

    PubMed  Google Scholar 

  18. Leung PC, Lam SF (1986) Long-term follow-up of children with femoral neck fractures. J Bone Joint Surg [Br] 68:537–540

    Google Scholar 

  19. Ratliff AHC (1978) Fractures of the neck of the femur in children. In: Lloyd-Roberts GC, Ratliff AHC (eds) Hip disorders in children. Butterworths, London, pp 165–199

    Google Scholar 

  20. Rigault P, Iselin F, Moreau J (1966) Fractures du col du fémur chez l'enfant: étude de 25 cas. Rev Chir Orthop 52:325–336

    PubMed  Google Scholar 

  21. Woodhouse CF (1964) Dynamic influences of vascular occlusion affecting the development of avascular necrosis of the femoral head. Clin Orthop 32:119–129

    PubMed  Google Scholar 

  22. Forlin E, Guille JT, Kumar SJ, Rhee KJ (1992) Transepiphyseal fractures of the neck of the femur in very young children. J Pediatr Orthop 12:164–168

    PubMed  Google Scholar 

  23. Nielsen PT, Thaarup P (1984) An unusual course of femoral head necrosis complicating an intertrochanteric fracture in a child. Clin Orthop 183:79–81

    PubMed  Google Scholar 

  24. Pförringer W, Rosemeyer B (1980) Fractures of the hip in children and adolescents. Acta Orthop Scand 51:91–108

    PubMed  Google Scholar 

  25. Digby KH (1915) The measurement of diaphyseal growth in proximal and distal direction. J Anat Physiol 50:187–197

    Google Scholar 

  26. Canale ST, King RE (1984) Fractures of the hip. In: Rockwood CA, Wilkins KE, King RE (eds) Fractures in children. Lippincott, Philadelphia, pp 782–821

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Azouz, E.M., Karamitsos, C., Reed, M.H. et al. Types and complications of femoral neck fractures in children. Pediatr Radiol 23, 415–420 (1993). https://doi.org/10.1007/BF02012436

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02012436

Keywords

Navigation