ObjectiveTo assess the effectiveness of pedicled iliac periosteal flap graft for treatment of avascular necrosis of the femoral head (ANFH) after femoral neck fracture in adolescents. MethodsBetween December 2006 and August 2011, 9 patients (9 hips) with ANFH after femoral neck fracture were treated with pedicled iliac periosteal flap graft. There were 6 males and 3 females with an average age of 14.7 years (range, 10-18 years). Fractures were caused by traffic accident injury (5 cases), falling injury from height (3 cases), and fall injury (1 case). The time from injury to internal fixation with Kirschner wires or cannulated screws was 3-16 days, and all fractures healed within 10 months after internal fixation. The interval between fracture fixation and ANFH was 10-42 months (mean, 24.4 months). According to Steinberg staging system, 1 hip was classified as stage Ⅲb, 2 hips as stage Ⅲc, 1 hip as stage IVa, 3 hips as stage IVb, and 2 hips as stage IVc. The Harris scores and Steinberg classification were compared between at pre- and post-operation to assess the outcomes clinically and radiologically. ResultsAll incisions healed by first intention. No complications of infection, deep venous thrombosis of lower limb, and pain and numbness of donor site were observed during or after operation. All patients were followed up 38-76 months (mean, 52 months). Joint pain was relieved; no leg length discrepancy was observed; the walking gait was improved and range of motion of hips was increased. The Harris score was significantly increased from 62.8±3.6 at pre-operation to 92.7±9.9 at last follow-up, showing significant difference (t=-12.244, P=0.000). The hip function was excellent in 5 hips, good in 3 hips, and poor in 1 hip, and the excellent and good rate was 88.89%. Post-operative radiological assessment demonstrated that only 1 hip (stage Ⅲb) had further collapse of the femoral head, the other hips had no incidence of deterioration. The radiological success rate was 88.89% (8/9). ConclusionThe pedicled iliac periosteal flap graft for ANFH after femoral neck fracture in adolescents can provide good osteogenesis and vascular reconstruction of the femoral head.
ObjectiveTo assess the effectiveness of percutaneous Kirschner wire poking reduction and elastic stable intramedullary nailing fixation for treating severe displaced radial neck fractures in children. MethodsBetween November 2010 and August 2014, 17 children with severe displaced radial neck fractures were treated with percutaneous Kirschner wire poking reduction and elastic stable intramedullary nailing fixation. There were 13 boys and 4 girls with an average age of 8.7 years (range, 6-14 years). The right side was involved in 9 cases, and the left side was involved in 8 cases. The causes of injury were falling in all cases. The angular deformity at fracture was 64-102° (mean, 84°). According to the Judet classification, 7 cases were classified as grade ⅠVa and 10 cases as grade ⅠVb. The time from injury to operation was 4.2 days (range, 1-7 days). Metaizeau classification and Tibone-Stoltz elbow performance score were used to access the radiological and clinical results, respectively. ResultsThe operation time was 20-50 minutes (mean, 30 minutes). All incisions healed by first intention. The patients were followed up 12-46 months (mean, 20 months). All fractures healed at 2 months after operation. There was no complication of malunion, early epiphyseal closure, avascular necrosis, enlargement of the radial head epiphysis, cubitus varus and valgus deformities, or proximal radioulnar joint synostosis. One case had elbow extension limitation. At last follow-up, the elbow range of motion in flexion, extension, pronation, and supination showed no significant difference between affected side and normal side (P>0.05). The clinical results were excellent in 16 cases and good in 1 case, with an excellent and good rate of 100%. The angulation was 0-12° (mean, 3.7°) on the X-ray film; anatomic reduction or nearly anatomic reduction was obtained, and the radiological results were excellent in 13 cases and good in 4 cases, with an excellent and good rate of 100%. ConclusionPercutaneous Kirschner wire poking reduction followed by fixation with elastic stable intramedullary nailing is a simple, safe, minimally invasive, and effective method to treat severe displaced radial neck fractures in children.