Therapeutic Effect Of Cannulated Screws In The Treatment Of Femural Neck Fractures In Children

Purpose:Fractures of the femoral neck are relatively common in adults,whereas Fractures of the femoral neck in children are relatively rare,accounting for less than 1% of Fractures in all children.Femoral neck fractures in children are usually caused by high-energy injuries such as car accidents and falls,with a 30% chance of developing injuries to limbs,parenchymal organs and the head.Although not as common as other fractures,complications from femoral neck fractures in children are high and the prognosis is poor.Complications include avascular osteonecrosis of the femoral head,varus of the hip,fracture nonunion,and premature closure of the epiphyseal plate.Therefore,the treatment of such fractures is more difficult than that of femoral neck fractures in adults.At present,there are a variety of treatment methods for femoral neck fracture in children,including conservative treatment of hip hernia plaster and surgical treatment of kirschner wire,hollow screw and DHS.In this paper,we retrospectively analyzed the treatment process of the patients with femoral neck fracture with open epiphyseal plate of children admitted to our department,and discussed the efficacy of hollow screw in the treatment of such fractures in order to provide some guidance in clinical practice.Materials and Methods:From June 2016 to October 2018,23 children with femoral neck fracture treated with hollow screw fixation were retrospectively analyzed.All subjects included in the study were patent femoral neck epiphyseal plate(M15,F 8).The mean age was 12.8 years.There were 16 cases of left hip and 7cases of right hip.There were no bilateral femoral neck fractures.The operation time from injury to admission: 4 cases within 12 hours,9 cases within 24 hours,7 cases within 48 hours,3 cases over 72 hours(mean 35hours).Among them,closed reduction was found in 15 cases,open reduction in 8 cases.Delbet classification: type Ⅰ 0 There were 18 cases of type Ⅱ,5 cases of type Ⅲ and 0 cases of type Ⅳ.Of these,11 of the screws were passed through the plate and 12 did not pass through the plate.All patients were treated with 2-3 Kg of skin pull to maintain the length of the lower limb and relieve the pain prior to the post-admission procedure.All patients were operated under general anesthesia.After successful anesthesia,the patient was fixed on the fracture traction bed in supine position,traction under C-arm fluoroscopy,adduction,reduction of internal rotation fracture.After two consecutive times of unsatisfactory reduction,open reduction was chosen.After anatomical reduction,two or three Kirschner pins were inserted along the femoral neck axis under the guidance of fluoroscopy.The parallel bit guide was used to ensure that all Kirschner pins were parallel to form a triangle or a shape.After the ideal position of the hollow screw was reached,the outer bone cortex was drilled with the open-skin drill into the lateral bone cortex,and the sounding of the ruler was measured.The hollow screw of corresponding length was screwed into the guide pin of the perforated Kjeldahl wire.Repertoire Both the positive side and the positive side of the fracture were anatomically reset,and the positive side of the hollow nail was located in the femoral neck.The activityof the affected limb is normal,the fracture is fixed,and the incision is closed.Postoperative imaging examination showed that functional exercise began when bony healing occurred.The follow-up time was 8-30 months(mean 15 months).We used the method of reduction,from injury to operation time,whether the screw traversed the epiphyseal plate as a variable to observe the results.Evaluate the results according to Ratliff standard.Result:According to Ratliff criteria,the prognosis was good in 17 cases,general in 3 cases and poor in 3 cases.There were 2 cases of nonunion(8.7%),1 case of necrosis of femoral head(4.3%),3 cases of shortening and varus of hip(13%).In all the 6 patients with postoperative complications,the epiphyseal plate was penetrated by screws,accounting for 55% of the patients with epiphyseal plate.Nonunion occurred in 1 of 4 patients within 12 hours,varus of hip and shortening of lower limb occurred in 1 of 9 patients within 24 hours.Within 48 hours,1 patient had nonunion and 1 patient had varus of hip.Within 72 hours,necrosis of femoral head occurred in 1 out of 3patients.Among the 8 patients who underwent open reduction and internal fixation,2 patients presented varus coxa,and among the 15 patients who underwent closed reduction and internal fixation,1 patient presented shortening of lower limb,2 patients presented nonunion,and 1 patient presented necrosis of femoral head.Conclusion:The healing of femoral neck fractures in adolescents is associated with avariety of factors.In addition to the age of the patient,the degree of fracture displacement,the type of fracture,the time of surgery after the injury,the method of surgical reduction and the depth of screw fixation.From the results of this study,we can draw the following conclusions: the earlier the operation time after injury,the lower the possibility of postoperative complications.Compared with closed reduction,open reduction can more accurately meet the standard of anatomic reduction and more easily achieve the compression fixation of fracture.The effect of screw crossing the epiphyseal plate on fracture healing is much greater than we had expected.Therefore,screws should not cross the epiphyseal plate in children with femoral neck fractures near the epiphyseal plate and be accompanied by hip hernia plaster external fixation postoperative.