O2136: Femoral Neck Fractures at an Urban, Pediatric Level 1 Trauma Center are Primarily Low-Energy Fractures Associated with Poor Bone Health

Background: Femoral neck fractures (FNF) are rare in children, having previously been reported as less than 1% of pediatric fractures and are generally attributed to high energy mechanisms. We investigated mechanism of injury and clinical course for FNFs at our institution over a 17-year period to better understand epidemiology and mechanisms of injury.

Methods: With Institutional Review Board (IRB) approval, we performed a data query using International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes to identify all patients with femur fractures at our institution from 2007 to 2024. Demographic and clinical data was collected through chart review.

Results: We identified 1598 femur fractures, 105 (6.57%) of which were FNF, excluding slipped capital femoral epiphysis (SCFE). Of the patients with FNFs, 18 (17.1%) had endocrine disorders, 14 (13.3%) had autism, 22 (21%) had metabolic bone disease, and 2 (1.9%) had muscular dystrophy. By mechanism, 54 (51.4%) patients had ground level falls (GLF), 3 (2.9%) were in motor vehicle crashes (MVC), 1 (1%) was a pedestrian versus auto, 4 (3.8%) fell from playground equipment, 8 (7.6%) fell from furniture, 5 (4.8%) fell from a height greater than 8 feet, and the remaining were classified as “other.” There was 1 patient with a concurrent femoral shaft fracture, 1 with a distal femur fracture, and 1 that developed a deep venous thrombosis (DVT). The majority (98 patients, 93%) were treated operatively.

Conclusion: Contrary to previous assumptions that pediatric FNF are due to “high energy mechanisms,” the majority of FNF within our cohort were due to low energy mechanisms compounded by coexisting metabolic and endocrine disorders and autism. Therefore, a higher index of suspicion in these patients, education, and Vitamin D and calcium supplementation may decrease the incidence of FNF amongst these populations. Furthermore, despite 93% of patients having surgery, only 1 patient developed a DVT. At our institution, no patients receive postoperative DVT chemoprophylaxis; thus, the very low incidence of DVT amongst our cohort supports that chemoprophylaxis is likely unnecessary in pediatric patients with FNFs.