Early prediction of outcomes in hip fractures: initial fracture displacement Özgür Baysal, Engin Eceviz, Güven Bulut and Halil İbrahim Bekler We retrospectively analyzed the surgical treatment of 28 pediatric hip fractures. The majority of cases were Delbet type 2 (57%) and type 3 (29%). The average age of the patients was 10.8 years (range: 2–16 years). The mean follow-up period was 91 months. Displaced fractures were found in 18 cases (64%). The major factor in the development of avascular necrosis was the degree of displacement at the time of initial presentation (P < 0.05), irrespective of fracture type. Although the degree of initial displacement cannot be prevented, careful exposure of soft tissue during open reduction will reduce avascular necrosis. J Pediatr Orthop B 25:228–233 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Journal of Pediatric Orthopaedics B 2016, 25:228–233 Keywords: hip fractures, initial displacement, outcomes, pediatric trauma Department of Orthopaedic and Traumatology, Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey Correspondence to Özgür Baysal, MD, Semsi Denizer Avenue E5 Highway, Cevizli - Kartal, Istanbul 34890, Turkey Tel: + 90 216 4413900/1421; fax: + 90 216 3055110; e-mail: drozgurbaysal@gmail.com Introduction Although the majority of pediatric fractures heal without difficulty using conservative treatment methods, femoral neck fractures require a different approach from the diagnosis stage forwards. Although these fractures are rarely seen, they can cause complications that may have life-long negative effects [1–13]. Following pediatric hip fractures, complications can occur such as avascular necrosis, nonunion, malunion, and shortness because of early physeal closure. Subsequently, infection, skin problems, and chondrolysis may develop associated with the treatment [14]. As these complica- tions lead to functional disability, the patient must be closely monitored from the time of the fracture until complete bone union. Complications following a hip fracture are not deter- mined by any single parameter. The quality of results varies depending on the initial amount of fracture dis- placement, the fracture type, the age of the patient, the time of fixation, the type and quality of reduction, and the type and number of fixation materials [7]. Avascular necrosis is the most frequently encountered and most serious complication following fractures of the proximal femur [14]. Primarily, the medial circumflex artery and the arteria femoris capitis provide the blood supply to the femoral neck region. The metaphyseal vessels providing the blood supply along the length of the femur toward the femoral head are absent at 15–18 months during physis development [13]. In addi- tion, the lateral circumflex artery is not evident until the age of 3 years. This tenuous blood supply to the femoral head is a direct cause of poor functional results after femoral neck fracture. The development of avascular necrosis is directly related to the initial fracture dis- placement or the displacement following reduction [14–16]. In pediatric hip fractures, the damage to the vessels providing the blood supply to the femoral head is proportional to the degree of fracture displacement and it is the most significant risk factor triggering the develop- ment of avascular necrosis. In this study, we examined the long-term results and complications of pediatric femoral neck fractures asso- ciated with degree of initial displacement, fracture type, method of treatment, duration of treatment, and the number and types of implants used. Methods A retrospective evaluation was performed of 35 pediatric patients with hip fractures who were surgically treated between 1997 and 2013. Of those patients, 28 were included in the study. A total of seven patients were excluded from the study because of factors that could negatively affect bone healing and functional results. Four patients had pathological frac- tures (tumors or bone cyst), two patients had cerebral palsy (evidence of osteoporosis), and one patient had a crush injury with an open fracture from an earthquake injury. Delbet classifications of fractures were determined: type 1 – two patients (7%), type 2 – 16 patients (57%), type 3 – eight patients (29%), and type 4 – two patients (7%). Thus, the majority of fractures (86%) were type 2 and type 3. If there was fracture line cortical continuity in the anteroposterior and lateral radiographic planes in the proximal femur, the fracture was defined as non- displaced. If the cortical continuity was separate from the 228 Original article 1060-152X Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/BPB.0000000000000263 Copyright r 2016 Wolters Kluwer Health, Inc. All rights reserved.