End-result evaluations after an average follow-up of seventeen years are
reported in sixty-one cases (sixty patients). There were five Type-1
(transepiphyseal), twenty-seven Type-II (transcervical), twenty-two
Type-III (cervicotrochanteric), and seven Type-IV (intertrochanteric)
femoral fractures. The majority of Type-I, Type-II, and displaced Type-III
fractures were treated with closed or open reduction and Knowles-pin
fixation. The majority of undisplaced Type-III and Type-IV fractures were
treated with abduction plaster spica casts. Fifty-five per cent were found
to have good resultswhile 20% were fair and 25%, poor. The incidence of
complications--avascular necrosis, coxa vara, premature epiphyseal closure,
infection, and non-union--was compared with that in previously reported
series. The use of Knowles-pin fixation appeared to reduce the
complications of non-union and coxa vara. Avascular necrosis caused most of
the poor results. However, younger children with avascular necrosis
obtained better results than did older ones. Some children with results
graded as poor roentgenographically were only mildly symptomatic.