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Pediatric Femoral Neck Fracture S72.019A 820.00

   

synonyms:

ICD-9 Classification / Treatment
Etiology / Natural History Associated Injuries / Differential Diagnosis
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References

Pediatric Femoral Neck Fracture ICD-10

 

A- initial encounter for closed fracture

B- initial encounter for open fracture type I or II

C- initial encounter for open fracture type IIIA, IIIB, or IIIC

D- subsequent encounter for closed fracture with routine healing

E- subsequent encounter for open fracture type I or II with routine healing

F- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing

G- subsequent encounter for closed fracture with delayed healing

H- subsequent encounter for open fracture type I or II with delayed healing

J- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing

K- subsequent encounter for closed fracture with nonunion

M- subsequent encounter for open fracture type I or II with nonunion

N- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion

P- subsequent encounter for closed fracture with malunion

Q- subsequent encounter for open fracture type I or II with malunion

R- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion

S- sequela

Pediatric Femoral Neck Fracture ICD-9

  • 820.00(closed unspecified intracapsular) 820.10(open unspecified intracapsular)
  • 820.01(closed ephiphseal separation) 820.11(open ephiphseal separation)
  • 820.02(closed midcervical) 820.12(open midcervical)
  • 820.03(closed base of neck) 820.13(open base of neck)
  • 820.09(closed other, head of femur, subcapital) 820.19 (open other)

Pediatric Femoral Neck Fracture Etiology / Epidemiology / Natural History

  • High risk of AVN and long term disability
  • Rare
  • High energy injury, MVC

Pediatric Femoral Neck Fracture Anatomy

  • Lateral epiphyseal artery, which is the terminal branch of the medial femoral circumflex artery of the profunda femoris circulation supplies the majority of the femoral head.(Trueta, JBJS 35B:442;1953).
  • Blood supply to femoral neck=extracapsilar arterial ring at base of neck supplied by branches of lateral and medial femoral circumflex artery, ascending cervical branches of arterial ring on surface of the neck, arteries of the ligamentum teres.
  • Fractures are usually entirely intracapsular thus bath in synovial fluid which may interfere with healing.
  • Neck has essentially no periosteal layer thus healing must be endosteal
  • See also Hip anatomy.

Pediatric Femoral Neck Fracture Clinical Evaluation

  • Generally non-ambulatory after fall onto the affected hip. Complain of hip or groin pain which is exacerbated by any hip ROM. Generally high energy injury, MVA.
  • Displaced fractures generally have obvious deformity with affected leg shortened and externally rotated.
  • Complete neurovascular exam indicated.

Pediatric Femoral Neck Fracture Xray / Diagnositc Tests

  • A/P pelvis and A/P & cross-table lateral of hip. Non-displaced fractures can be difficult to see on plain films. Consider 15 degree internal rotation A/P which allows visualization of the entire femoral neck.
  • MRI  is indicated to evaluate for occult hip fracture. MRI can be performed within 24 hrs of injury and is more accurate and cost-effective than bone scanning in

Pediatric Femoral Neck Fracture Classification / Treatment

  • Delbert Classification
  • Urgent reduction, fixation and decompression are indicated to reduce risk of AVN and long term disability.
  • Type I( transepiphyseal), age <8y/o: rare typically infants to 6yrears old. Treatment open/closed anatomic reduction and fixation with smooth Steinmand pins or cannulated screws.smooth pins across the physis, decompression and spica casting for 4-6 weeks. high risk of AVN.
  • Type I( transepiphyseal), age >8y/o:Can occur during reduction of hip dislocation in pts >11yrs old.  Treatment: 4.5mm or 7.3mm screws and decompression. high risk of AVN.
  • Type II(transcervical), age <3y/o: smooth pins across the physis, decompression and spica casting for 4-6 weeks.
  • Type II (transcervical), age 3-10yrs old: 4.5mm or 7.3mm screws (not crossing physis), decompression and spica casting for 4-6 weeks.
  • Type II (transcervical), >10yrs old: 7.3mm screws across the physis and decompression.
  • Type III (cervicotrochanteric / basicervical), age <3y/o: smooth pins across the physis and decompression and spica casting for 4-6 weeks. 
  • Type III (cervicotrochanteric / basicervical), age 3-10yrs old: 4.5mm or 7.3mm screws (not crossing physis), decompression and spica casting for 4-6 weeks.: 25% osteonecrosis
  • Type III (cervicotrochanteric), >10yrs old: 7.3mm screws across the physis and decompression.
  • Type IV(peritrochanteric): sliding hip screw and decompression in all patients. Lowest risk of AVN

Pediatric Femoral Neck Fracture Associated Injuries / Differential Diagnosis

  • Pediatric femoral shaft fracture
  • Pediatric acetabular fracture
  • Pediatric pelvic fracture

Pediatric Femoral Neck Fracture Complications

  • Avascular necrosis: up to 42%.  (MoonES, JPT 2006;20:323).  AVN: 50% of transcervical fractures; 100% of transepiphyseal fractures; 25% of cervico-trochanteric fractures; 15% of peritrochanteric fractures.
  • Malunion
  • Coxa vara: second most common complication.
  • Premature physeal closure
  • Limb length discrepancy
  • Chondrolysis
  • Stress fracture around hardware
  • Post-traumatic arthritis
  • Malunion

Pediatric Femoral Neck Fracture Follow-up Care

  • Hardware is removed as soon as union is varified.

Pediatric Femoral Neck Fracture Review References

  • Cheng JC, JPO 1999;19:338.
  • Flynn JM, JBJS 2002;84Br:108
  • Beaty JH Orthop Clin North AM 2006;37:223 °
  • Boardman MJ, Herman MJ, Buck B, Pizzutillo PD. Hip fractures in children. J Am Acad Orthop Surg. 2009 Mar;17(3):162-73. Review.

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