Avascular necrosis after femoral neck fracture in children and adolescents: poor prognosis and risk factors

Li, Ziqi; Zhuang, Zhikun; Hong, Zhinan; Chen, Leilei; He, Wei; Wei, Qiushi

doi:10.1007/s00264-021-05210-2

Cited by 8 publications

(4 citation statements)

References 35 publications

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“…The high failure rate of femoral neck fracture procedures in younger patients remains challenging [ 9 ]. FNS has been used as a new surgical modality for treating femoral neck fractures.…”

Section: Discussionmentioning

confidence: 99%

Prediction of hip joint function and analysis of risk factors for internal fixation failure after Femoral Neck System (FNS)

Zhang,

et al. 2023

BMC Musculoskelet Disord

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Objective Analysis of the risk factors affecting hip function and complications after femoral neck system (FNS) surgery for femoral neck fractures is of great significance for improving the procedure’s efficacy. Methods The data of patients with femoral neck fractures who underwent FNS surgery in our hospital between October 2019 and October 2020 were retrospectively analyzed. Age, gender, time from injury to operation, fracture classification, operation time, fracture reduction, and postoperative weight-bearing time information were set as potential factors that may affect the results. Hip Harris scores were performed at 12 months postoperatively, and postoperative complication data (e.g., femoral head necrosis, nonunion, and femoral neck shortness) were collected. The risk factors affecting hip function and complications after FNS surgery were predicted using linear and logistic regression analyses. Results A total of 69 cases of femoral neck fracture were included, with an average age of 56.09 ± 11.50 years. The linear analysis demonstrated that the age and fracture type of the patients were the risk factors affecting the Harris score of the hip joint after FNS surgery. Older patients with displaced femoral neck fractures had an inferior postoperative hip function. In addition, fracture type, reduction of the femoral neck, and postoperative weight-bearing significantly impacted postoperative complications. Displaced fractures, negative fixation, and premature weight-bearing (< 6 weeks) were risk factors for postoperative complications. The Harris score of patients with a shortened femoral neck in the included cases was not significantly different from that of patients without shortening (P = 0.25). Conclusions Advanced age and fracture type are important evaluation indicators of the Harris score after FNS internal fixation of femoral neck fractures in young patients. Fracture type, fracture reduction, and postoperative weight-bearing time are risk factors for complications after FNS.

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“…The high failure rate of femoral neck fracture procedures in younger patients remains challenging [ 9 ]. FNS has been used as a new surgical modality for treating femoral neck fractures.…”

Section: Discussionmentioning

confidence: 99%

Prediction of hip joint function and analysis of risk factors for internal fixation failure after Femoral Neck System (FNS)

Zhang,

et al. 2023

BMC Musculoskelet Disord

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“…In 2021, ve of these patients with their informed consent (two male and three female), with a minimal follow-up period of 15 years, were examined (Table 1). The mean age of these patients at the time of injury was 13.6 years (range, [12][13][14][15][16][17][18][19] and at the time of VITO 16.7 years (range, 14-21); the mean injury-VITO interval was 36 months (range, . The average follow-up was 17 years (range; [15][16][17][18][19][20].…”

Section: Methodsmentioning

confidence: 99%

“…The most severe complication of femoral neck fractures in children and adolescents is avascular necrosis of the femoral head (ANFH) [1][2][3][4][5][6][7][8][9]. The published studies describe multiple methods of its treatment, ranging from core decompression up to total hip replacement [7,[10][11][12][13][14]. One of these methods is intertrochanteric osteotomy (ITO) based on the principle of reorientation of the necrotic segment of the femoral head away from the weight-bearing zone of the hip joint [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Long-term results of valgus intertrochanteric osteotomy for partial avascular necrosis of the femoral head after femoral neck fracture in adolescents

Chochola

Bartoníček

Douša

et al. 2023

Preprint

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Purpose: The study evaluates long-term results in patients treated by valgus intertrochanteric osteotomy (VITO) for partial avascular necrosis of the femoral head (ANFH) after fracture of the femoral neck in adolescent age. Although this method is mentioned in literature frequently, there are only few studies in the literature dealing with it in detail. Methods: Authors evaluated five patients at the interval of 15 to 20 years following VITO. The mean age of the patients at the time of injury was 13.6 years and at the time of VITO 16.7 years. The studied parameters included resorption of necrotic segment of femoral head, development of posttraumatic osteoarthritis and leg shortening Results:Comparison of radiographs and MRI scans before and after VITO showed resorption of the necrotic segment of the femoral head and its remodeling in all five patients. However, two patients gradually developed slight osteoarthritic changes. In one patient, remodeling of the femoral head occurred during the first 6 years postoperatively. Subsequently, the patient developed severe osteoarthritis with marked clinical symptoms. Conclusion:VITO can improve the long-term function of the hip joint in adolescents with ANFH after a femoral neck fracture, but cannot restore completely the original shape and structure of the femoral head.

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“…Ischemia, necrosis, and collapse are characteristic pathological processes associated with ONFH[ 1 , 2 ]. The hip is one of the most important weight-bearing joints in the human body[ 3 ], and structural and pathological changes of this joint often lead to pain, dysfunction, and even disability[ 4 ]. Those suffering from ONFH are mostly young or middle-aged[ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of individual shock wave therapy vs celecoxib on hip pain caused by femoral head necrosis

Zhu¹,

Yan²,

Xiao³

et al. 2023

World J Clin Cases

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BACKGROUND Celecoxib has been used to treat hip discomfort and functional difficulties associated with osteonecrosis of the femoral head (ONFH), although significant adverse reactions often follow long-term use. Extracorporeal shock wave therapy (ESWT) can delay the progression of ONFH, alleviate the pain and functional limitations it causes, and avoid the adverse effects of celecoxib. AIM To investigate the effects of individual ESWT, a treatment alternative to the use of celecoxib, in alleviating pain and dysfunction caused by ONFH. METHODS This was a randomized, controlled, double-blinded, non-inferiority trial. We examined 80 patients for eligibility in this study; 8 patients were excluded based on inclusion and exclusion criteria. A total of 72 subjects with ONFH were randomly assigned to group A ( n = 36; celecoxib + alendronate + sham-placebo shock wave) or group B ( n = 36; individual focused shock wave [ESWT based on magnetic resonance imaging three-dimensional (MRI-3D) reconstruction] + alendronate). The outcomes were assessed at baseline, at the end of treatment, and at an 8-wk follow-up. The primary outcome measure was treatment efficiency after 2 wk of intervention using the Harris hip score (HHS) (improvement of 10 points or more from the baseline was deemed sufficient). Secondary outcome measures were post-treatment HHS, visual analog scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. RESULTS After treatment, the pain treatment efficiency of group B was greater than that of group A (69% vs 51%; 95%CI: 4.56% to 40.56%), with non-inferiority thresholds of -4.56% and -10%, respectively. Furthermore, the HHS, WOMAC, and VAS scores in group B dramatically improved during the follow-up period as compared to those in group A ( P < 0.001). After therapy, the VAS and WOMAC in group A were significantly improved from the 2 nd to 8 th wk ( P < 0.001), although HHS was only significantly altered at the 2 wk point ( P < 0.001). On the 1 st d and 2 nd wk after treatment, HHS and VAS scores were different between groups, with the difference in HHS lasting until week 4. Neither group had severe complications such as skin ulcer infection or lower limb motor-sensory disturbance. CONCLUSION Individual shock wave therapy (ESWT) based on MRI-3D reconstruction was not inferior to celecoxib in managing hip pain and restrictions associated with ONFH.

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Avascular necrosis after femoral neck fracture in children and adolescents: poor prognosis and risk factors

Cited by 8 publications

References 35 publications

Prediction of hip joint function and analysis of risk factors for internal fixation failure after Femoral Neck System (FNS)

Prediction of hip joint function and analysis of risk factors for internal fixation failure after Femoral Neck System (FNS)

Long-term results of valgus intertrochanteric osteotomy for partial avascular necrosis of the femoral head after femoral neck fracture in adolescents

Effects of individual shock wave therapy vs celecoxib on hip pain caused by femoral head necrosis

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