Collum neck fracture in child - proposal

Dislocated femoral neck fracture in an 11 years old girl


Requests of the treatment:

  • early reduction (within 6 hours, better faster)
  • reduction without damage to the medial circumflex artery
  • better not to cross the growing plate with the implants (or use K-wire and cross the growth plate)

Proposed approaches:

  • lateral-anterolateral: Christian Kammerlander (Munich); Nunzio Catena (Alessandria)
  • anteriorRiccardo Cepparulo (Borgotaro); Michael Memminger (Bolzano)

Proposed devices:

  • Screws
  • Plates

Comments

  • Nunzio Catena (Alessandria): Closed reduction if possible fixing the fracture with plate and screws
  • Riccardo Cepparulo (Borgotaro): riduzione open con accesso anteriore e capsulotomia per una riduzione della frattura e sintesi con lamaplacca
  • Reza Shojaie (Mashhad): Urgent reduction and fixation with cannulated screw or pediatric DHS
  • Christian Kammerlander (Munich): standard lateral approach, cannulated screws with short thread, not penetrating the groth plate

Consideration

good approaches for the reduction are: lateral-anterolateral and anterior approach

  • anterolatel: anterior capsulotomy, easy reduction, advantage: if you use a plate you can bring this inside in an easy manner through the same incision
  • anterior: very good visibility to the neck and easy reduction, useful if you use cannulated screws through a small percutaneous second incision. If you want to use a plate it's difficult to bring it inside through the same incision, you must lengthen the incision much more or do a second incision more lateral.

OP case description with anterior approach:

  • Riccardo Cepparulo: anterior approach, fixation with plate and screws, see the case description. Link:Case Borgotaro
  • M.Memminger: description of the presented case. Link: Case Bolzano.

Bolzano: We used an anterior incision with partial detachment of the rectus femuris tendon, anterior capsulotomy, easy open reduction. Then fiaxtion with 2 cannulated screws 4.5 (introduced percutaneously) reaching the growth plate, without crossing of it. 

 

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