Avascular necrosis (AVN) of the femoral head is a serious complication of pediatric femoral neck fractures. We report a case of femoral neck fracture in childhood who was treated with prolonged offloading to get healing without femoral head collapse. A 6-year-old girl sustained a left femoral neck fracture (Delbet-Colonna type III) following a skiing accident. Closed reduction and internal fixation were performed four days post-injury. AVN was diagnosed 5-month postoperatively, after implementing a stepwise protocol of restricted weight-bearing, beginning with complete non-weight-bearing and gradually progressing to partial weight-bearing. Due to her young age and absence of collapse, conservative management with prolonged offloading was continued. At 12 months, MRI showed reduced necrotic area with preserved femoral head architecture. The patient was discharged without recurrence after achieving full weight-bearing at 14 months. In pediatric patients with post-traumatic AVN, prolonged offloading may reduce necrotic area and prevent femoral head collapse, thereby lead to favorable long-term outcomes.
Shiraishi et al. (Sun,) studied this question.