Displaced femoral neck fractures in children: Are complications predictable?

Dendane, M.A.; Amrani, A.; Alami, Z.; Medhi, T. El; Gourinda, H.

doi:10.1016/j.otsr.2009.11.007

Cited by 50 publications

(56 citation statements)

References 17 publications

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“…Most SCFE deformities occur with gradual displacement of the femoral head from the metaphysis and with risk of avascular necrosis (AVN) up to 4.6% [28]. However, abrupt and complete disconnection of the epiphysis from the metaphysis -a so-called unstable slip -is not uncommon and has been associated with incidences of AVN ranging from 4.7% to 58% [5,13,24,36,37,44,47]. However, the exact cause for AVN developing in patients with SCFE remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Clinical Stability of Slipped Capital Femoral Epiphysis does not Correlate with Intraoperative Stability

Ziebarth

Domayer

Slongo

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background The most important objective of clinical classifications of slipped capital femoral epiphysis (SCFE) is to identify hips associated with a high risk of avascular necrosis (AVN) -so-called unstable or acute slips; however, closed surgery makes confirmation of physeal stability difficult. Performing the capital realignment procedure in SCFE treatment we observed that clinical estimation of physeal stability did not always correlate with intraoperative findings at open surgery. This motivated us to perform a systematic comparison of the clinical classification systems with the intraoperative observations. Questions/purposes We asked: (1) Is the classification of an acute versus chronic slip based on the duration of symptoms sensitive and specific in detecting intraoperative disrupted physes in patients with SCFE? (2) Is the stable/ unstable classification system based on clinical symptoms sensitive and specific in detecting intraoperative disrupted physes in patients with SCFE? Methods We retrospectively reviewed 82 patients with SCFE treated by open surgery between 1996 and 2009. We classified the clinical stability of all hips using the classifications based on onset of symptoms and on function. We classified intraoperative stability as intact or disrupted. We determined the sensitivity and specificity of two classification systems to determine intraoperative stability. Results Complete physeal disruption at open surgery was seen in 28 of the 82 hips (34%). With classification as acute, acute-on-chronic, and chronic, the sensitivity for disrupted physes was 82% and the specificity was 44%. With the classification of Loder et al., the values were 39% and 76%, respectively. Conclusion Current clinical classification systems are limited in accurately diagnosing the physeal stability in SCFE.

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Section: Introductionmentioning

confidence: 99%

Clinical Stability of Slipped Capital Femoral Epiphysis does not Correlate with Intraoperative Stability

Ziebarth

Domayer

Slongo

et al. 2012

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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“…Younger patients tend to have better outcomes [20,25,26], and our patient is one of the youngest ever described in the literature for bilateral femoral neck fractures [13,14]. Generally, this type of fracture has been reported to have a favorable outcome in up to 91% of cases [26].…”

Section: Discussionmentioning

confidence: 65%

“…However, other causative factors such as inappropriate patient selection for nonoperative treatment [6,15], the surgeon's lack of experience, pin penetration through physis [6,16], or inadequate reduction are also suspected [6,17]. The type of fracture, initial displacement, and the patient's age are considered by some researchers as the main factors that determine the outcome [3,6,16,[18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Bilateral femoral neck fracture in a child

Mazurek

Lorczyński

Ceynowa

2011

Journal of Pediatric Orthopaedics B

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A long-term follow-up of bilateral femoral neck fracture is presented. The patient sustained the injury in a road accident at the age of five. Both fractures were Delbet type III. Three days after the injury, open reduction and internal fixation were performed. A hip spica cast was applied for 8 weeks. Follow-up radiographs show uneventful healing, with no avascular necrosis of the femoral head. The initial shortening of the right proximal femur persisted. The left femur shows extensive remodeling of the femoral head toward valgus. The patient is painless and currently does some sports.

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“…From the remaining 34 studies, 25 studies were screened out following reading the abstracts and 3 studies were further eliminated after reading full texts. Finally, a total of 6 studies were included in this meta‐analysis. As shown in Table , there were 198 patients in these 6 studies, including 118 males and 80 females.…”

Section: Resultsmentioning

confidence: 99%

Poor Outcomes of Children and Adolescents with Femoral Neck Fractures: A Meta‐Analysis Based on Clinical Studies

Chen

Zhang²,

Guo

et al. 2020

Orthopaedic Surgery

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Objective: To comprehensively assess the differences in outcome between open reduction and closed reduction for children and adolescents with femoral neck fractures.Methods: Based on the predetermined strategies, eligible studies were obtained by searching Embase, the Cochrane Library, and PubMed databases (retrieval time: June 2018) and through manual retrieval for paper documents. The 95% confidence intervals (CI) and risk ratios (RR) were used as evaluation indexes. Moreover, the results of avascular necrosis, coxa vara, or non-union were compared between open reduction and closed reduction under random or fixed effects models. After sensitivity analysis was carried out, publication bias was evaluated for the eligible studies using Egger's test.Results: Six studies were included in our meta-analysis. No significant heterogeneity was found among the included studies (P ≥ 0.05) and, thus, the fixed effects model was used for merging the effect sizes of avascular necrosis (RR [95% CI] = 0.50 [0.26, 0.98], P = 0.04), coxa vara (RR [95% CI] = 0.16 [0.04, 0.70], P = 0.01), and non-union (RR [95% CI] = 0.22 [0.05, 0.93], P = 0.04). Sensitivity analysis suggested that the results of avascular necrosis were not stable (RR = 0.50, 95% CI = 0.25 1.17, P = 0.12), while those of coxa vara and non-union were stable. There was no significant publication bias among the eligible studies (t = −0.70, P = 0.522).Conclusion: Femoral neck fractures treated by open reduction had less adverse outcomes compared with those treated by closed reduction.

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Displaced femoral neck fractures in children: Are complications predictable?

Abstract: Retrospective study, level IV.

Cited by 50 publications

References 17 publications

Clinical Stability of Slipped Capital Femoral Epiphysis does not Correlate with Intraoperative Stability

Clinical Stability of Slipped Capital Femoral Epiphysis does not Correlate with Intraoperative Stability

Bilateral femoral neck fracture in a child

Poor Outcomes of Children and Adolescents with Femoral Neck Fractures: A Meta‐Analysis Based on Clinical Studies

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