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Vascular evaluation after cervical hip fractures in children: a case series of eight children examined by scintigraphy after surgery for cervical hip fracture and evaluated for development of secondary radiological changes.

Juréus, Jan LU ; Geijer, Mats LU ; Tiderius, Carl Johan LU and Tägil, Magnus LU (2016) In Journal of Pediatric Orthopedics. Part B 25(1). p.17-23
Abstract
Femoral neck fractures in children and young adults are rare, but have a high risk of avascular necrosis (AVN) and subsequent gradual collapse of the femoral head. In 2006, we initiated the use of scintigraphy for the diagnosis of vascular impairment after a cervical fracture in children. In the present retrospective case study, we evaluated the effect of the remaining postoperative circulation in the femoral head after fracture in terms of the development of AVN and secondary degenerative changes of the hip joint. Eight children, four girls and four boys [mean age 11.5 years (7-16)], had been operated for a cervical or a basocervical hip fracture between 2006 and 2012. The femoral head circulation was evaluated postoperatively with... (More)
Femoral neck fractures in children and young adults are rare, but have a high risk of avascular necrosis (AVN) and subsequent gradual collapse of the femoral head. In 2006, we initiated the use of scintigraphy for the diagnosis of vascular impairment after a cervical fracture in children. In the present retrospective case study, we evaluated the effect of the remaining postoperative circulation in the femoral head after fracture in terms of the development of AVN and secondary degenerative changes of the hip joint. Eight children, four girls and four boys [mean age 11.5 years (7-16)], had been operated for a cervical or a basocervical hip fracture between 2006 and 2012. The femoral head circulation was evaluated postoperatively with scintigraphy and all children had been followed radiographically for a minimum of 1 year. The Ficat classification was used to stage the AVN and the Stulberg classification was used to stage the sphericity of the femoral head at follow-up. In two patients, the femoral head had normal circulation postoperatively and they also had normal radiographs at follow-up. In two patients, the entire femoral head was avascular postoperatively and at follow-up, one patient had normal radiographs and one had both subchondral sclerosis and flattening. These two patients had been treated with bisphosphonates and prolonged non-weight-bearing. Four patients had postoperatively retained circulation in parts of the femoral head. Three of these four patients had normal radiographs at follow-up. Evaluation of the remaining circulation after surgery may help to predict the outcome and guide the postoperative regime in children with a femoral neck fracture. (Less)
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type
Contribution to journal
publication status
published
subject
in
Journal of Pediatric Orthopedics. Part B
volume
25
issue
1
pages
17 - 23
publisher
Lippincott Williams & Wilkins
external identifiers
  • pmid:26288375
  • wos:000365714200004
  • scopus:84948703721
ISSN
1473-5865
DOI
10.1097/BPB.0000000000000217
language
English
LU publication?
yes
id
8b161c33-c2d7-4b8f-b1fb-6b64f444ac71 (old id 7840567)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/26288375?dopt=Abstract
date added to LUP
2015-09-06 15:13:29
date last changed
2017-01-01 03:00:59
@article{8b161c33-c2d7-4b8f-b1fb-6b64f444ac71,
  abstract     = {Femoral neck fractures in children and young adults are rare, but have a high risk of avascular necrosis (AVN) and subsequent gradual collapse of the femoral head. In 2006, we initiated the use of scintigraphy for the diagnosis of vascular impairment after a cervical fracture in children. In the present retrospective case study, we evaluated the effect of the remaining postoperative circulation in the femoral head after fracture in terms of the development of AVN and secondary degenerative changes of the hip joint. Eight children, four girls and four boys [mean age 11.5 years (7-16)], had been operated for a cervical or a basocervical hip fracture between 2006 and 2012. The femoral head circulation was evaluated postoperatively with scintigraphy and all children had been followed radiographically for a minimum of 1 year. The Ficat classification was used to stage the AVN and the Stulberg classification was used to stage the sphericity of the femoral head at follow-up. In two patients, the femoral head had normal circulation postoperatively and they also had normal radiographs at follow-up. In two patients, the entire femoral head was avascular postoperatively and at follow-up, one patient had normal radiographs and one had both subchondral sclerosis and flattening. These two patients had been treated with bisphosphonates and prolonged non-weight-bearing. Four patients had postoperatively retained circulation in parts of the femoral head. Three of these four patients had normal radiographs at follow-up. Evaluation of the remaining circulation after surgery may help to predict the outcome and guide the postoperative regime in children with a femoral neck fracture.},
  author       = {Juréus, Jan and Geijer, Mats and Tiderius, Carl Johan and Tägil, Magnus},
  issn         = {1473-5865},
  language     = {eng},
  number       = {1},
  pages        = {17--23},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Journal of Pediatric Orthopedics. Part B},
  title        = {Vascular evaluation after cervical hip fractures in children: a case series of eight children examined by scintigraphy after surgery for cervical hip fracture and evaluated for development of secondary radiological changes.},
  url          = {http://dx.doi.org/10.1097/BPB.0000000000000217},
  volume       = {25},
  year         = {2016},
}