Management of a neglected femoral neck fracture A case report and review of literature

Abstract

Femoral neck fractures are less frequent in children. A neglected femoral neck fracture is one where there has been a delay of more than 30 days to seek medical attention from the time of injury¹. It is one of the most challenging problems encountered by orthopaedic surgeons especially in young adults and children. Avascular necrosis (AVN) is a severe complication following a neglected fracture neck of femur in children with a reported incidence of 15 %. We report a case of a young girl presenting with neglected displaced fracture neck of femur that was successfully managed by initial immobilisation with skeletal traction followed by a closed reduction and internal fixation using dynamic hip screws. No clinical or radiological signs of avascular necrosis were observed in the 1 year of follow-up. Remarkable post-operative improvement in the symptoms and decrease in the limp was noted. Patient had no hip pain or discomfort. Accurate anatomical reduction and internal fixation are crucial to reduce the incidence of avascular necrosis after femoral neck fracture. Internal fixation with dynamic hip screw is a reliable method with decent long-term functional outcomes even in children.