Arthrotomy and open reduction of the displaced fracture of the femoral neck in children

The objective of the study was to examine the efficacy of limited arthrotom y coupled with open reduction and internal fixation to minimize potential c omplications of vascular disruption of the capital femoral physis and femor al epiphysis. It was a patient outcome study. Skeletally immature patients with femoral neck fractures were treated according to a protocol in which a ll patients underwent limited arthrotomy with decompression of the intercap sular hematoma, open reduction and internal fixation. Radiographic and magn etic resonance imaging studies were carried out on patients to assess wheth er avascular necrosis developed in the postoperative period. Patients were followed for a mean length of 2 years 8 months, with a range of 2 years to 5.5 years. Twelve patients had good results and one had fair results using Ratliff criteria. No patient developed avascular necrosis (ischemic necrosi s), coxa vara, nonunion or premature epiphyseal closure. This study support s the hypothesis that limited decompression of the intracapsular hematoma i n children with femoral neck fractures may be a factor in obviating the sub sequent appearance of ischemic disruption of the epiphysis and physis.