Outcome of early versus delayed presentation of proximal femur fractures in children: A prospective cohort study

Abstract

Objective

We hypothesized that the exact time of fixation of paediatric proximal femur fractures will have an effect on the ultimate clinical and radiological outcome. This article aimed to compare the clinical–radiological outcomes in paediatric proximal femur fractures having early and delayed presentation.

Methodology

A prospective cohort study was conducted from January 2019 to November 2022 in patients of age of 5 to 16 years presented with proximal femur fracture and divided into two groups: group A: early presentation, presented <48 hours of injury; group B: delayed presentation, presented >48 hours of injury. Patients underwent internal fixation treatment modality and followed up to assess clinical outcomes and radiological outcomes, and final outcome was assessed as per Ratliff's criteria.

Results

In the study of 44 patients, 72.72% were male, and 27.27% were female, with male-to-female ratio to be 2.6:1. The commonest mode of injury was fall from height accounting for 52.27% followed by road traffic accidents (RTA) in 38.63%. The most common fracture type observed was Delbet type II, which was observed in 43.18%. There was significant shorter duration of surgery in group A (p-value = 0.013), VAS score (p = 0.045), and limb length discrepancy (p = 0.022). Also, there was a statistical difference in AVN (p-value = 0.0295) and growth disturbance (p-value = 0.0394) between two groups. Also, there was statistically significant difference between Ratliff's criteria two groups (p-value = 0.030).

Conclusion

Early presentation has shorter duration of surgery, less VAS score at final follow-up, and less limb length discrepancy, less development of complications like avascular necrosis of the femoral head, and growth disturbance.

Level of evidence

III.