Approaches and fixation of femoral neck fractures in children—transgluteal approach

Ziebarth, Kai; Kaiser, Nadine; Slongo, Theddy (2021). Approaches and fixation of femoral neck fractures in children—transgluteal approach. Operative Orthopädie und Traumatologie, 33(1), pp. 36-45. Springer 10.1007/s00064-020-00694-4

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Objective: Transgluteal approach for anatomical reduction of femoral neck fractures (extra-intraarticular) in children under preservation of the blood supply of the femoral head.

Indications: Femoral neck fractures AO 31-M/2.1 I‑III; 31-M/3.1 I‑III; 31-M/3.2 I‑III.

Contraindications: None.

Surgical technique: Preparation of a muscular flap including the proximal insertion of the vastus lateralis muscle and approximately one third of the gluteus medius muscle. Elevation of the gluteus minimus muscle from the hip capsule without completely detaching it from its insertion. Exposure of the anterolateral hip capsule and capsulotomy followed by controlled reduction of the fracture fragments without compromising the retinacular vessels.

Postoperative management: Touch-down weightbearing for 4-6 weeks (age dependent). To protect the healing of the abductors, active abduction or passive adduction prohibited for 4-6 weeks. Consolidation radiographs 4-6 weeks postoperatively.

Results: Excellent results in 29 patients subsequently treated in the last 10 years by the transgluteal approach. No cases of avascular necrosis of the femoral head by this procedure.

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