Early versus late treatment of paediatric femoral neck fractures: a systematic review and meta-analysis

Alkhatib, Nedal; Younis, Manaf H; Hegazy, Abdelsalam; Ibrahim, Talal

doi:10.1007/s00264-018-3998-4

Cited by 26 publications

(32 citation statements)

References 28 publications

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“…Risk factors for the development of AVN are diverse. Studies have suggested patient’s age, gender, type of fracture, capsular decompression, time to surgery, and method of fixation as independent risk factors for the same [ 6 , 12 - 13 , 18 - 19 ].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Avascular Necrosis of the Femoral Head in Pediatric Femoral Neck Fractures

Chaudhary¹,

Garg²,

Mishra³

et al. 2021

Cureus

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IntroductionA neck of femur fracture is a rare injury in the pediatric population and is of foremost importance, as it is associated with a high rate of complications. It usually occurs due to high-velocity trauma or a fall from a height. There is a scarcity of data on risk factors and their role in the prognostication of avascular necrosis. The purpose of the study was to retrospectively analyze the association of various risk factors with avascular necrosis (AVN) of the femoral head in patients with a neck of femur fracture in the pediatric age group. Material and methodsThe study included 21 (13 males and 8 females) pediatric patients with a neck of femur fracture treated at a university-level hospital. The patients were followed for a minimum of one year and the clinico-radiological outcome was analyzed using Ratliff criteria. The association of AVN with age, gender, side, fracture type, and injury with treatment delay, type of reduction, and type of internal fixation used was studied. ResultsThe mean age of the treated patients was 11 (±3.178) years (range=5-16 years). Avascular necrosis was seen in four patients and coxa vara occurred in two of them. A statistically significant association was seen between the Delbet fracture type and avascular necrosis, and three out of four cases of AVN were a Type I fracture (p-value=0.006). Three out of six patients having concomitant skeletal or other organ injuries developed AVN (p-value=0.022). The rate of AVN was higher in patients who were managed after 48 hours of initial injury but no statistically significant correlation was found (p-value=0.314). No statistically significant association with AVN was found between gender, age, type of reduction (closed/open), or the implant used (cannulated screws/k-wires). ConclusionsMultiple independent factors may have a role in the development of AVN of the femoral head in children. Prognostication should not be based on a single factor. Statistically significant results in this study have shown that the type of fracture and concomitant skeletal or other organ injuries are important risk factors and should be kept in mind. All independent risk factors must be noted and should be considered while prognosticating the outcome of a child with a neck of femur fracture.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Avascular Necrosis of the Femoral Head in Pediatric Femoral Neck Fractures

Chaudhary¹,

Garg²,

Mishra³

et al. 2021

Cureus

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“…[1][2][3][4] They are frequently associated with high-energy trauma such as falling from a significant height, as in the case of this patient, or from high-speed motor vehicle accidents. [1][2][3][4] Since the femoral head is exclusively supplied by the lateral epiphyseal artery with no anastomosis between the epiphysis and femoral neck, injury to this area can lead to complications such as avascular necrosis (AVN), bone non-union, coxa vara, chondrolysis, premature physeal closure, and infection. 2 AVN is the most common and serious complication, and the rate of AVN varies significantly between 0% -92% among different reports.…”

Section: Discussionmentioning

confidence: 95%

“…2 AVN is the most common and serious complication, and the rate of AVN varies significantly between 0% -92% among different reports. 1 Surgical reduction of femoral neck fracture with either closed or open internal fixation realign the bone to preserve vascular supplies and prevent the progression of AVN and nonunion. 3 Study shows that patients with delayed surgical intervention of >24 hours were 4.5 times more likely to develop AVN compared to early intervention of < 24 hours.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Typically, this is a result of a high-energy trauma or fall from significant height. [1][2][3][4] This type of injury requires urgent surgery to prevent long term complications such as avascular necrosis, coxa vara, chondrolysis, premature physeal closure, and infection. [1][2][3][4]…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4] This type of injury requires urgent surgery to prevent long term complications such as avascular necrosis, coxa vara, chondrolysis, premature physeal closure, and infection. [1][2][3][4]…”

Section: Introductionmentioning

confidence: 99%

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