Management of Pediatric Femoral Neck Fracture

Joseph T. Patterson, MD; Jennifer Tangtiphaiboontana, MD; Nirav K. Pandya, MD


J Am Acad Orthop Surg. 2018;26(12):411-419. 

In This Article

Abstract and Introduction


In the pediatric population, femoral neck fracture is a relatively uncommon injury with a high complication rate, despite appropriate diagnosis and management. The anatomy and blood supply of the proximal femur in the skeletally immature patient differs from that in the adult patient. Generally, these fractures result from high-energy trauma and are categorized using the Delbet classification system. This system both guides management and aids the clinician in determining the risk of osteonecrosis after these fractures. Other complications include physeal arrest, coxa vara, and nonunion. Multiple fracture fixation methods have been used, with the overall goal being anatomic reduction with stable fixation. Insufficiency fractures of the femoral neck, although rare, must also be considered in the differential diagnosis for the pediatric patient presenting with atraumatic hip pain.


Pediatric femoral neck fractures are rare injuries that carry the risk of serious complications and potential long-term disability. Single-institution series from academic pediatric tertiary referral centers have reported pediatric femoral neck fracture incidence rates of 1.2 to 2 cases per year, suggesting that femoral neck fractures annually account for 0.3% to 0.5% of fractures in children.[1–4] The peak incidence is at age 10 to 13 years (range, 1 day to 18 years), with a 1.3 to 1.7:1 ratio of boys to girls.[3,5,6] At long-term follow-up, adverse outcomes, which include pain and disability secondary to osteonecrosis, coxa valga, proximal femoral physeal arrest, and nonunion, are reported in 20% to 50% of patients.[1–3,7–9] The clinician must understand the current principles of diagnosis, treatment, postoperative care, and management of complications to optimize outcomes in this population.