Open Reduction of Pediatric Femoral Neck Fractures Reduces Osteonecrosis Risk

Abstract

Pediatric femoral neck fractures are rare injuries that are associated with a high risk of osteonecrosis of the femoral head. This study compared pediatric patients with fully displaced femoral neck fractures treated with either open reduction and internal fixation (ORIF) or closed reduction and internal fixation (CRIF). After institutional review board approval was obtained, the authors identified 53 patients who were treated for femoral neck fracture between 2003 and 2012. Inclusion criteria were as follows: (1) diagnosis of a fully displaced femoral neck fracture with no anatomic cortical contact; (2) age of at least 4 years; and (3) clinical/radiographic follow-up of at least 1 year. Medical records and radiographs were retrospectively reviewed. Excluded from the study were 16 patients who had fractures that were not fully displaced, 4 who were outside of the eligible age range, 1 who had insufficient radiographs, and 10 who had insufficient follow-up. Of the 22 patients included, 6 were treated with ORIF and 16 were treated with CRIF. Treatment groups were compared with Fisher's exact test for categorical outcome data and the Wilcoxon rank-sum test for continuous variables. There was a significantly (P=.051) greater occurrence of osteonecrosis after CRIF (50%) than after ORIF (0%). Further, patients who underwent ORIF had a higher (P=.009) quality of reduction, a higher (P=.046) rate of anatomic union, and fewer (P=.009) complications than those who underwent CRIF. Major complications occurred in significantly fewer (P=.015) hips after ORIF than after CRIF. No significant difference (P=.477) was seen between groups, according to the Ratliff assessment of final results. Fully displaced pediatric femoral neck fractures treated with ORIF had a significantly higher quality of reduction, with fewer complications, including osteonecrosis, than those treated with CRIF.

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

“…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.…”

“…All of the 6 included studies were retrospective clinical studies. The publication years of the included studies were from 2010 to 2016, and their study areas included China, India, Korea, the USA and Morocco. Except for the study of Bali et al .…”

“…Except for the study of Bali et al . (involving 28 displaced fracture cases and 8 undisplaced fracture cases), the studies only included displaced fracture cases. The characteristics and the outcomes of the eligible studies are presented in Tables and , respectively.…”

“…The results of the meta‐analysis for avascular necrosis showed that there was no significant heterogeneity among the 6 included studies ( I 2 = 9%, P = 0.36), and, thus, the fixed effects model was used (RR [95% CI] = 0.50 [0.26, 0.98], P = 0.04) (Fig. ).…”

“…). Moreover, the meta‐analysis results for non‐union indicated that there was no significant heterogeneity in 4 studies ( I 2 = 0%, P = 0.94), and the fixed effects model was also used (RR [95% CI] = 0.22 [0.05, 0.93], P = 0.04) (Fig. ).…”