Presentation
2 week history of fall from a tree.
Patient Data
There is a left transcervical neck of femur fracture which is displaced. This corresponds to Delbet classification type II (transcervical).
Cannulated screw fixation of left transcervical neck of femur fracture.
Case Discussion
This case highlights two important learning points:
neck of femur (NOF) fracture in a child, and
delayed diagnosis increasing risk of avascular necrosis (AVN).
NOF fractures are generally uncommon in children, making up <1% of all pediatric fractures, and when present, are generally associated with high energy mechanisms like the one in this case - fall from a height. Transcervical fractures are the most common and make up about 50% of the cases 1.
In this particular case, unfortunately an initial x-ray was not performed when the patient first presented to emergency. Due to ongoing pain for two weeks, and inability to weight bear on affected side, patient presented to another emergency department where above findings were picked up and orthopedics was consulted who eventually took over care of the patient.
AVN of the femoral head is the most common complication following a NOF fracture. The risk for a displaced Delbet type II fracture such as the one in this case is up to 61% and further increases with delayed presentation. Other complications include Coxa vara (neck shaft angle <120 degrees), growth arrest, chondrolysis and rarely infection.
Patient was taken to surgery for screw fixation and would likely require further surgeries in near future.
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