|
Year |
2006 |
|---|---|
|
Question Number |
113 |
|
Category |
Pediatric Orthopaedics |
Question
A 9-year-old girl sustains the fracture shown in Figure 37. What is the most likely complication following open reduction and internal fixation of this fracture?
1- Sciatic nerve palsy
2- Nonunion
3- Osteonecrosis
4- Chondrolysis
5- Coxa valga
Figures
Answer (click for answer)
The correct answer is 3.
Shown is a Type III femoral neck fracture (cervicotrochanteric) according to the Delbet classification. This is the second most common type of proximal femoral fracture in children. The review article describes this and the other types of femoral head and neck fractures and cites AVN as the most frequent and serious complication seen in 17-47% of fractures. AVN appears to be directly related to degree of displacement at the time of injury.
#1 is incorrect as there is no correlation between sciatic nerve palsy and femoral neck fx
#2 is incorrect as non-union is infrequent (6-10% of fx)
#3 is correct for as it is seen in 17-47% of fx
#4 is incorrect as it has only been cited in one study and associated with AVN
#5 is incorrect as coxa vara (not valga) is seen with these fx (20-30% of fx)
Delbet classification
Type I: transepiphyseal separation of the femoral head +/- dislocation
Type II: transcervical fx
Type III: cervicotrochanteric fx
Type IV: Intertroch fx
Reference: Blasier DR. Hughes LO: Fractures and traumatic dislocations of the hip in children, in Beaty JH, Kasser JR (eds): Rockwood and Wilkin’s Fractures in Children, Ed 5. Philadelphia, PA, Lippincott Williams & Wilkins, 2001, pp913-939.
Hughes LO, Beaty JH: Fractures of the head and neck of the femur in children. JBJS (Am) 1994; 76: 283-292.
