Collum neck fracture in child - proposal
Dislocated femoral neck fracture in an 11 years old girl
Requests of the treatment:
- early reduction (within 6 hours, better faster)
- reduction without damage to the medial circumflex artery
- better not to cross the growing plate with the implants (or use K-wire and cross the growth plate)
- lateral-anterolateral: Christian Kammerlander (Munich); Nunzio Catena (Alessandria)
- anterior: Riccardo Cepparulo (Borgotaro); Michael Memminger (Bolzano)
- Nunzio Catena (Alessandria): Closed reduction if possible fixing the fracture with plate and screws
- Riccardo Cepparulo (Borgotaro): riduzione open con accesso anteriore e capsulotomia per una riduzione della frattura e sintesi con lamaplacca
- Reza Shojaie (Mashhad): Urgent reduction and fixation with cannulated screw or pediatric DHS
- Christian Kammerlander (Munich): standard lateral approach, cannulated screws with short thread, not penetrating the groth plate
good approaches for the reduction are: lateral-anterolateral and anterior approach
- anterolatel: anterior capsulotomy, easy reduction, advantage: if you use a plate you can bring this inside in an easy manner through the same incision
- anterior: very good visibility to the neck and easy reduction, useful if you use cannulated screws through a small percutaneous second incision. If you want to use a plate it's difficult to bring it inside through the same incision, you must lengthen the incision much more or do a second incision more lateral.
OP case description with anterior approach:
- Riccardo Cepparulo: anterior approach, fixation with plate and screws, see the case description. Link:Case Borgotaro
- M.Memminger: description of the presented case. Link: Case Bolzano.
Bolzano: We used an anterior incision with partial detachment of the rectus femuris tendon, anterior capsulotomy, easy open reduction. Then fiaxtion with 2 cannulated screws 4.5 (introduced percutaneously) reaching the growth plate, without crossing of it.