Femoral Neck Fracture in Children- Decompression, Anatomic Reduction and Use of Kirchner Wires to the Rescue?

Femoral neck fracture in children is very rear. Whenever it occurs, it presents a challenge to the orthopaedic surgeon. There are schools of thought on immediate capsular aspiration and surgery. However, some do not believe that capsular decompression and immediate surgery prevent avascular necrosis of the femur. This is the reason for this report, to lend my findings to the debate. This patient is a 7year old female child. She was a victim of truck-pedestrian injury. It was a high energy trauma with resultant displaced intertrochanteric femoral neck fracture(Delbert type IV). There was mild head injury which she recovered from. She did not have capsular decompression. She had open reduction and internal fixation 8 days after injury. We used smooth Kirchner wires for fixation. She was kept on strict bed rest. 6weeks after surgery, she had radiological union and commenced guarded ambulation with a walker(Zimmer frame). Six months post injury, there is no sign of avascular necrosis and patient walks full weight bearing without pain. Conclusion: Delayed surgery in a displaced femoral fracture in children did not affect surgery outcome. Open arthrotomy and immediate decompression may not be necessary in displaced femoral neck fracture. Open and anatomic reduction may be a way to reduced poor outcome.