CORRELATION BETWEEN AVASCULAR NECROSIS AND EARLY STABILIZATION OF PROXIMAL FEMORAL FRACTURES IN CHILDHOOD

Diego da Costa Astur; Gustavo Gonçalves Arliani; Carolina Lins E Silva Nascimento; Francesco Camara Blumetti; Marcio José Alher Fonseca; Eiffel Tsuyoshi Dobashi; José Antonio Pinto; Akira Ishida

doi:10.1016/S2255-4971(15)30392-X

CORRELATION BETWEEN AVASCULAR NECROSIS AND EARLY STABILIZATION OF PROXIMAL FEMORAL FRACTURES IN CHILDHOOD

Rev Bras Ortop. 2015 Nov 17;45(4):426-32. doi: 10.1016/S2255-4971(15)30392-X. eCollection 2010 Jul-Aug.

Authors

Diego da Costa Astur¹, Gustavo Gonçalves Arliani¹, Carolina Lins E Silva Nascimento², Francesco Camara Blumetti³, Marcio José Alher Fonseca³, Eiffel Tsuyoshi Dobashi⁴, José Antonio Pinto⁵, Akira Ishida⁶

Affiliations

¹ Resident Physician in the Department of Orthopedics and Traumatology, Paulista School of Medicine, Federal University of Sao Paulo, Sao Paulo, SP.
² Undergraduate Medical Student at the Paulista School of Medicine, Federal University of Sao Paulo, Sao Paulo, SP.
³ Orthopedist in the Department of Orthopedics and Traumatology, Paulista School of Medicine, Federal University of Sao Paulo, Sao Paulo, SP.
⁴ PhD in Medicine. Head of Clinical Medicine in the Discipline of Pediatric Orthopedics, Department of Orthopedics and Traumatology, Federal University of Sao Paulo, Sao Paulo, SP.
⁵ Adjunct Professor and Head of the Discipline of Pediatric Orthopedics, Department of Orthopedics and Traumatology, Federal University of Sao Paulo, Sao Paulo, SP.
⁶ Titular Professor Titular and Head of the Department of Orthopedics and Traumatology, Federal University of Sao Paulo, Sao Paulo, SP.

Abstract

Objective: We developed this study with the aim of evaluating the results from treating patients with proximal femoral fractures, in a series of cases. We sought to observe the influence of the most prevalent complications on the final results after a minimum follow-up of two years. We especially considered the relationship between establishment of avascular necrosis and the time between the accident and the therapeutic intervention.

Method: We retrospectively studied proximal extremity fractures of the femur in 29 patients under 14 years of age between 1988 and 2007. We analyzed the following variables: sex, age, mechanism of injury, fracture classification (Delbet), treatment administered, complications (pseudarthrosis, varus deformity, leg length discrepancy and avascular necrosis), duration of surgery and results (Ratliff). We carried out individual descriptive analysis on each variable. The tests were used in accordance with the premise that normality applied. For the evaluation, we used Fisher's exact test.

Results: Five patients (17.2%) had avascular necrosis, and three of them (60.0%) were over 10 years of age. 73.3% of the patients treated within the first 24 hours showed good results. The most common cause of fractures was traffic accidents (44.8%). The best results were observed among 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 the Ratliff criteria. When conservative treatment was applied, only 17.0% had good results, while 69.3% had good results from surgical intervention. Likewise, 73.3% of the results were good results when surgery was performed within the first 24 hours and only 42.8% of the results were good among patients who underwent surgery after this period. Patients operated within the first 24 hours developed necrosis of the femoral head in 13.3% of cases, while 21.4% of those operated after this period developed this complication.

Keywords: Child; Femoral fractures/epidemiology; Femoral fractures/surgery.