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Abstract：
The primary objective of this study was to juxtapose the union rate and incidence of complications in paediatric patients presenting early (≤ 7 days) following injury with children presenting later (> 7 days) with femoral neck fractures. This critical appraisal evaluated 15 patients according to their timing of presentation and surgery from the initial day of injury (Group A: operated ≤ 7 days or Group B: > 7 days of injury). Patients with traumatic femoral neck fractures with Delbet 1 to 4 subtypes who were skeletally immature (age ≤ 16 years) were included in the study. Pathological fractures and post-infective fractures were not included. Each patient\'s secondary loss of reduction was calculated by measuring the Neck shaft angle (NSA) on the immediate post-operative radiograph and at the union. A change in NSA of ≥ 5 degrees was considered a significant loss of reduction. Ratliff\'s Criteria was used to analyze the final result, and a thorough record of complications was kept. There were no significant variations in the two groups\' with respect to distributions of age, sex, injury mechanism, or fracture pattern. The most frequent injury culprit in both groups was falling from a height. Type II fracture pattern (54.54%) was more common in group A, while Type III and Type II fracture pattern was equally distributed in group B. In group A, the mean operation time was 55 ± 8.25 minutes, whereas in group B, it was 65 ± 15 minutes (p-value > 0.05). In group A, 90.9% of patients underwent CCS fixation, and in group B, 75% underwent fixation by CCS. The quality of reduction in post-operative radiographs was anatomical in 10 (90.9%) patients and unacceptable in 1 (9.1%) patient. In group B, 2 (50%) patients had an anatomical reduction, while 2 (50%) patients had an unacceptable reduction. Timing of reduction and its association with complications showed that early stable reduction and fixation decrease the occurrence of complications in femoral neck fractures (p-value = 0.033). Fracture union was seen in all our patients in both groups and none of our patients underwent non-union. The mean union time was 11.11 ± 7.06 weeks in group A and 16.5 ± 2.59 weeks in group B (p-value = 0.0189). In group A, only 1 (9.1%) patient developed coxa vara. In group B, out of 4 patients, the femoral head of one patient underwent avascular necrosis, one patient exhibited coxa vara, and 1 patient developed premature physeal closure with limb length inequality. Management of femoral neck fractures in children is challenging because of the paediatric bone\'s peculiar anatomic and physiological considerations. In our study, patients operated within 7 days developed fewer complications as compared to patients who were operated after 7 days, which was statistically significant. Although AVN is a frequent adverse consequence of pediatric femoral neck fractures, early reduction and stable fixation lowers AVN rates, as observed in our study. Our short-term functional and radiological results using the Ratliff scoring system were comparable to previous studies owing to stable anatomic reduction. Based on our findings and the existing literature, we emphasize long-term follow-up and recommend an early stable anatomic reduction in the treatment of paediatric femoral neck fractures.
摘要：
这项研究的主要目的是将受伤后早期（≤7天）的儿科患者与股骨颈骨折患儿（>7天）的愈合率和并发症发生率并列。这项关键评估评估了15例患者从受伤的第一天开始的就诊时间和手术时间（A组：手术≤7天或B组：受伤>7天）。该研究包括骨骼不成熟（年龄≤16岁）的Delbet1至4种亚型的创伤性股骨颈骨折患者。病理性骨折和感染性骨折不包括在内。通过测量术后即刻X线片和工会处的颈部轴角（NSA）来计算每位患者的二次减少。NSA的变化≥5度被认为是显著的减少损失。使用Ratliff的标准来分析最终结果，并保留了并发症的完整记录。两组在年龄分布方面没有显著差异，性别,损伤机制,或断裂模式。两组中最常见的受伤罪魁祸首是从高处坠落。Ⅱ型骨折类型(54.54%)在A组中更常见,而B组III型和II型骨折分布相等。平均手术时间为55±8.25分钟，而在B组中，时间为65±15分钟(p值>0.05)。在A组中,90.9%的患者接受CCS固定术,在B组中,75%接受CCS固定。术后X线照片的质量降低在10例（90.9％）患者中是解剖学的，在1例（9.1％）患者中是不可接受的。B组,2（50％）患者的解剖减少，而2例（50％）患者出现不可接受的减少。复位时机及其与并发症的关系表明，早期稳定的复位和固定可减少股骨颈骨折并发症的发生（p值=0.033）。两组中所有患者均见骨折愈合，没有患者发生骨不连。平均愈合时间A组为11.11±7.06周,B组为16.5±2.59周(p值=0.0189)。在A组中,只有1例(9.1%)患者发生了髋内翻.B组,4个病人中,一名患者的股骨头发生了缺血性坏死，一名患者表现为髋部静脉曲张，1例患者因肢体长度不等而过早闭合。由于儿科骨骼的特殊解剖和生理考虑，儿童股骨颈骨折的治疗具有挑战性。在我们的研究中,与7天后手术的患者相比，7天内手术的患者并发症较少，具有统计学意义。尽管AVN是小儿股骨颈骨折的常见不良后果，早期复位和稳定固定降低AVN率，正如在我们的研究中观察到的那样。由于稳定的解剖还原，我们使用Ratliff评分系统的短期功能和放射学结果与以前的研究相当。根据我们的发现和现有文献，我们强调长期随访,并建议在小儿股骨颈骨折的治疗中早期稳定解剖复位.
