Efficacy and complications after delayed fixation of femoral neck fractures in children

Abstract

Objective: This study evaluated the efficacy of surgery for femoral neck fractures in children after a 24-h delay and the factors affecting the risk of complications. Methods: The study included 16 children who underwent surgery after the first 24 h for femoral neck fractures. According to Delbet’s classification, there were 2 type I, 11 type II, and 3 (four hips) type III cases. The mean time from injury to surgery was 85 h (range 27–240 h). According to Garden’s classification, there were 1 type II, 14 type III, and 1 type IV (two hips) cases. Initial surgery consisted of closed reduction and hematocele drainage with a 20-mL needle tube. If the procedure failed, open reduction was performed. Internal fixation (K-wire pinning, screw) was performed after closed ( n = 9) or open ( n = 8) reduction. The results were assessed using the Ratliff criteria after a mean follow-up of 23.2 months. Patient age, type of fracture, complications, treatment, and avascular necrosis (AVN) were evaluated. Results: The results were good in 15 hips (88.2%) and fair in 2 hips (11.8%, one type II case with closed reduction and one type I case with open reduction). The most frequent complication was AVN (4 of 17; 23.5%; three Ratliff good and one fair), which was significantly related to poor outcomes. AVN occurred in one hip in the closed reduction group (Delbet’s type II, 12.5%) and in three in the open reduction group (one Delbet’s type I, 50%; two Delbet’s type II, 66.7%). There were no significant differences in the time from injury to operation (27, 54, 64, and 116 h) and AVN incidence or Ratliff criteria. Conclusions: The efficacy of delayed reduction fixation of the femoral neck was better in the closed reduction group than in the open reduction group. Fracture location closer to the femoral head and older age affected the incidence of AVN.

The Risk of Avascular Necrosis Following the Stabilization of Femoral Neck Fractures: A Systematic Review and Meta-Analysis

“…The sample size ranged from 17 to 417 participants. Three studies reported solely on pediatric populations [ 16 , 17 , 18 ], while nine studies included only participants above 50 years of age [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. The studies included those that reported the use of both closed and open fracture-reduction techniques and employed a wide range of implants, most commonly cannulated screws (28 studies).…”

“…A total of 25 studies reported both the number of included patients with displaced fractures and the incidence of AVN in these patients [ 17 , 18 , 21 , 27 , 28 , 30 , 32 , 36 , 37 , 38 , 39 , 40 , 42 , 43 , 44 , 45 , 50 , 52 , 53 , 56 , 59 , 60 , 65 , 66 , 67 ], and they were included in the meta-analysis. For undisplaced fractures, the corresponding data were available for analysis from 28 studies [ 17 , 18 , 19 , 21 , 22 , 23 , 24 , 26 , 27 , 28 , 29 , 30 , 32 , 34 , 37 , 38 , 39 , 40 , 42 , 43 , 44 , 45 , 50 , 51 , 52 , 53 , 60 ,…”

“…Data on the incidence of AVN by Garden stage were derived from studies reporting both the number of patients with a given stage and AVN incidence for that stage. A total of 10 studies reported Garden stage I fractures [ 17 , 21 , 30 , 37 , 38 , 42 , 44 , 45 , 51 , 61 , 66 ], 10 studies reported Garden stage II fractures [ 17 , 21 , 27 , 30 , 37 , 38 , 42 , 44 , 45 , 66 ], 13 reported Garden stage III [ 17 , 21 , 27 , 30 , 36 , 37 , 38 , 42 , 44 , 45 , 56 , 65 , 66 ] fractures, and 12 reported Garden stage IV fractures [ 17 , 21 , 30 , 36 , 37 , 38 , 42 , 44 , 45 , 56 , 65 , 66 ]. The pooled mean incidence of AVN was 13.6% for stage I (95% CI: 0–28.4%); 12.2% (95% CI: 0–26.2%) for stage II; 17.0% for stage III (95% CI: 6.4–27.6%); and 32.8% for stage IV (95% CI: 11.8–53.8%) with no significant differences between the Garden stages.…”

Letter to the Editor

“…J Orthop Surg (Hong Kong), 2020, 28(1) by Wu C et al DOI: 2309499019889682 I have read with great interest the article in your journal by Wu C et al titled "Efficacy and complications after delayed fixation of femoral neck fractures in children." 1 There is an ongoing debate in the literature on the effect of various factors on outcome of pediatric femoral neck fractures with no consensus in near future. 2 The authors have done a wonderful study correlating avascular necrosis (AVN) rates with method of reduction, age, displacement and type of fracture.…”

Key concerns in the management of pediatric hip fractures—What does the literature say?

“…To the editor, At the outset, I would like to congratulate the authors of the article published in your journal in the current issue entitled "Efficacy and complications after delayed fixation of femoral neck fractures in children." 1 However, certain concerns are required to be addressed for the benefit of the readers of this article.…”