Can formation of avascular necrosis really be prevented in Delbet type 2 femoral neck fractures?

BACKGROUND: Fractures of proximal femur are rarely seen in childhood. These fractures can result in serious complications such as avascular necrosis (AVN), coxa vara, and early closure of the femoral epiphysis. The aim of this study is to investigate retrospectively the Delbet type 2 fractures that are commonly seen and has high rates of AVN.
METHODS: Forty-two patients whose Delbet type 2 fractures were treated in our hospital between January 2009 and June 2018 were analyzed. The patients’ mechanism of fracture formation, displacement of the fracture, presence of accompanying injuries, timing of surgery, open or closed reduction, whether the screws cross the epiphyseal growth plate epiphyseal line, and AVN data were analyzed retrospectively.
RESULTS: Of the 42 screened patients, 34 patients with complete follow-up graphs and files were included in the study. The mean age of the patients was 11.02 years (1–17 years old), and the mean follow-up time was 40.82 months (range 24 to 98 months). When the follow-up radiographs of the patients were examined, it was found that AVN in 9 patients (26.5%), coxa vara in 2 patients (5.9%), and non-union in 1 patient (2.9%). The AVN rate was significantly higher in patients with high-energy injuries and high fracture displacement at baseline (p=0.034 and p=0.047, respectively).
CONCLUSION: According to our findings in Delbet type 2 fractures, other than the severity of the trauma and the initial displacement of the fracture, factors related to the treatment process do not have a significant effect on the development of AVN. Age was not determined as a risk factor for the development of AVN in these patients.

Delbet tip 2 femur boyun kýrýklarýnda avasküler nekroz oluþmasý gerçekten engellenebilir mi?

AMAÇ: Çocuklarda proksimal femur kýrýklarý oldukça nadir görülmektedir. Bu kýrýklar avasküler nekroz, koksa vara, femurbaþý epifizinin erken kapanmasý gibi ciddi komplikasyonlarla sonuçlanabilmektedir. Bu çalýþmanýn amacý en çok görülen ve avasküler nekrozun yoðun olarak saptandýðý delbet tip 2 kýrýklarýn geriye dönük incelenmesini içermektedir.
GEREÇ VE YÖNTEM: Hastanemizde Ocak 2009 - Haziran 2018 yýllarý arasýnda tedavi edilen Delbet tip 2 kýrýklarý olan 42 hasta tarandý. Hastalarýn, kýrýklarýn oluþum mekanizmasý, kýrýðýn deplase olup olmamasý, eþlik eden yaralanmalarýn varlýðý, cerrahi zamanlamasý, açýk ya da kapalý redüksiyon yapýlmasý ve vidalarýn epifiz hattýný geçip geçmemesi, AVN verileri geriye dönük olarak incelendi.
BULGULAR: Taranan 42 hastadan takip grafileri ve dosyalarý tam olan 34 hasta çalýþmaya dahil edildi. Hastalarýn yaþ ortalamasý 11.02 yýl (1–17 yaþ arasý), ortalama takip süresi 40.82 ay (24–98 ay) idi. Hastalarýn takip grafileri incelendiðinde dokuz hastada (%26.5) avasküler nekroz, iki hastada (%5.9) koksa vara, bir hastada (%2.9) kaynamama geliþtiði saptandý. Yüksek enerjili yaralanmasý olan ve baþlangýçta kýrýk deplasmaný fazla olan hastalarda AVN oraný anlamlý olarak daha yüksek saptandý (sýrasýyla, p=0.034, p=0.047).
TARTIÞMA: Delbet tip 2 kýrýklarda bulgularýmýza göre, travmanýn þiddeti ve kýrýðýn ilk yer deðiþtirmesi dýþýnda tedavi süreciyle ilgili faktörlerin avasküler nekroz (AVN) geliþimi üzerinde önemli bir etkisi yoktur. Bu hastalarda yaþ AVN geliþimi için risk faktörü olarak belirlenmemiþtir.