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

Chaudhary, Sunny; Garg, Varun; Mishra, Dipun; Yasam, Rama Priya; Barik, Sitanshu; Sinha, Shandip Kumar; Singh, Vivek

doi:10.7759/cureus.16776

Cited by 4 publications

(9 citation statements)

References 28 publications

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“…In our study, all patients were treated surgically with internal fixation and coxa vara was observed in two (8%) patients; coxa vara could be easily tolerated (105° and 110° in two patients) as those patients had no symptoms and had good Harris Hip Score (HHS). this finding was consistent with the literature ( 10 ). However, it was unclear whether the cross-epiphyseal fixation had reduced the risk of coxa vara incidence.…”

Section: Discussionsupporting

confidence: 94%

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Postoperative clinical outcome and complications of combined cannulated cancellous screw with Kirschner wire in adolescent femoral neck fractures

et al. 2023

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PurposeFractures of the femoral neck account for less than 1% of pediatric and adolescent fractures. Due to the high incidence of complications, and the age of the patients, the choice of fixation approach remains controversial among orthopedic surgeons. This study aimed to evaluate the postoperative outcomes and complications of femoral neck fracture in adolescents with open physis, following transphyseal fixation using a combined cannulated cancellous screw and Kirschner wire fixation.MethodsData of 19 patients aged between 12 and 19 years from January 2010 to January 2021 were retrospectively studied. The follow-up period was 1–11 years (5.83 ± 3.76 years). The variables of interest including demographic and clinical variables [age, BMI, gender, side of injury, fracture classification, operation time, time to surgery, and length of hospital stay (LOS)], postoperative outcomes, and complications (fracture healing time, nonunion, coxa vara, osteoarthritis, avascular necrosis, screw loosening, and femoral shortening) were analyzed. The assessment of the hip function was done on the final follow-up using the Ratliff scoring system.ResultsThere was a male predominance of 76%; the mean age was 16.14 ± 1.57 years and the most frequent mechanism of injury was fall from a height. Delbet type II and III were the most encountered. The mean intraoperative time was 54.71 ± 7.85 min, the LOS was 8.34 ± 1.81days, and the time to surgery was 2.60 ± 1.16 days; the fracture healing time was 3.31 ± 1.04 months. The postoperative complications encountered were coxa vara osteoarthritis, spontaneous dislocation, and neck shortening. Clinical assessment revealed good results in 89% of patients and fair results in 11% of patients.ConclusionTransphyseal fixation using cannulated cancellous screw combined with Kirschner wire in our patients provided acceptable results. Thus, this approach can be a viable alternative in the management of adolescent femoral neck fracture with open physis.

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Section: Discussionsupporting

confidence: 94%

“…The Delbet classification was used to evaluate the risk of complication and was categorized following the definition available in the literature as Delbet type I (transepiphyseal), type II (transcervical), type III (cervicotrochanteric), and type IV (intertrochanteric) ( 7 , 8 , 10 , 20 ).…”

Section: Methodsmentioning

confidence: 99%

Postoperative clinical outcome and complications of combined cannulated cancellous screw with Kirschner wire in adolescent femoral neck fractures

et al. 2023

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“…The data on fracture Delbet typing was available in 12 studies ( 9 – 11 , 13 , 14 , 16 – 22 ) and was analysed through Meta-analysis. Two studies ( 13 , 22 ) did not report any cases of type I fractures, and six studies ( 9 – 11 , 17 , 19 , 20 ) did not report any cases of type IV fractures. Type II and III fractures were reported in all included studies.…”

Section: Meta-analysis Resultsmentioning

confidence: 99%

“…The correlation between the timing of the procedure and postoperative AVN was examined in a meta-analysis. (9,20), which generally suggests that the occurrence of AVN is positively correlated with the timing of the procedure, and early surgical treatment is recommended. However, a meta-analysis (30) showed that the occurrence of postoperative AVN is not related to the timing of surgery (≤24 h, >24 h).which is similar to the results of this meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

Risk factors related with avascular necrosis after internal fixation of femoral neck fractures in children: a systematic review and meta-analysis

Wang

et al. 2023

Front. Pediatr.

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BackgroundLess than 1% of children develop femoral neck fractures (FNF), making them uncommon. However, they may have dangerous side effects, like avascular necrosis. Even though several risk factors for postoperative avascular necrosis have been identified, there is still debate regarding them. In this investigation, a meta-analysis was performed to examine the potential causes of postoperative avascular necrosis in children with FNF.MethodsWe conducted a thorough literature search to find risk factors for avascular necrosis (AVN) after internal fixation of pediatric FNF. Until December 2022, we searched several databases, including PubMed, Embase, Cochrane Library, Web of Science, CNKI, Orthosearch, and Sinomed. Software Zotero 6.0 and Stata 17.0 were used to organise and synthesise the data. Finally, a sensitivity and publication bias test was carried out.ResultsOur study includes a total of 15 case-control studies involving 814 patients. The risk of postoperative AVN increased with age at fracture encounter (95% CI: 0.64–1.88, P = 0.0003), initial fracture displacement (95% CI: 1.87–9.54, P = 0.0005), and poor fracture reduction (95% CI:1.95–22.34, P = 0.0024) were risk factors for postoperative AVN. There was no significant relationship between gender and postoperative AVN (95% CI: 0.52–1.31, P = 0.41). Conversely, Postoperative AVN and reduction methods have no connection with each other (95% CI: 0.77–2.66, P = 0.25), procedure time (95% CI: 0.43–2.99, P = 0.16), or injury mechanism (95% CI: 0.32–2.26, P = 0.75). The incidence of post-operative AVN varies between Delbet fracture types (95% CI: 0.15–0.31, P < 0.0001), with the overall trend being that the incidence of post-operative AVN is highest for type II, lowest for type IV, and close for types I and III, but it is not clear which type of fracture is the independent risk factor. Funnel plots indicate no significant publication bias.ConclusionsIn line with this study, About 26% of children who underwent surgery for a femoral neck fracture suffered postoperative AVN. The main risk factors for AVN were the child's age, the initial displacement of the fractures, and poorly reduced fractures. The risk of AVN did not significantly correlate with gender, the time of the procedure, reduction methods or the mechanism of injury. The overall trend in the incidence of postoperative AVN for the different Delbet types of fracture is that the incidence of postoperative AVN is highest for type II, lowest for type IV, and close for types I and III, but it is not clear which type of fracture is the independent risk factor.

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“…Studies that consider the timing of surgical fixation suggest that early reduction [40] is necessary to avoid ischaemic injury [19,41,42]. The risk of AVN, however, may be determined by the patients age [43] and fracture pattern [44], irrespective of how and when the proximal femur is stabilized [19,42].…”

Section: Proximal Femoral Fracturesmentioning

confidence: 99%

Traumatic injuries of the immature hip and pelvis

Moore,

Gnap,

Monsell

2023

Current Opinion in Pediatrics

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Purpose of review The pelvis and hip account for 0.3--4% of fractures of the immature skeleton, and generally result from high energy trauma. These fractures range in severity from apophyseal avulsions to complete disruptions of the pelvic ring. The purpose of this article is to review the presentation, diagnosis, treatment and complications of these injuries in order to inform clinicians involved in their management. There is a lack of evidence-based management protocols for fractures of the immature pelvis largely due to their rarity and lack of robust scientific literature on the topic. Recent findings Computed tomography/MRI is essential as up to 30% of pelvis and 70% of acetabular fractures are not identified on initial radiographs. A sub-optimal outcome is common in unstable fractures treated conservatively and adequate reduction and surgical stabilization is often required to avoid long-term morbidity. Summary A coordinated approach involves resuscitation and temporary stabilization with planned definitive fixation. It is generally accepted that these injures should be managed in paediatric trauma centres. Whilst injuries vary in pattern and severity, we present an overview that considers the evaluation and treatment of the paediatric patient with pelvic and hip fractures to ensure that these injuries are identified promptly and treated by surgeons familiar with contemporary management algorithms.

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

Cited by 4 publications

References 28 publications

Postoperative clinical outcome and complications of combined cannulated cancellous screw with Kirschner wire in adolescent femoral neck fractures

Postoperative clinical outcome and complications of combined cannulated cancellous screw with Kirschner wire in adolescent femoral neck fractures

Risk factors related with avascular necrosis after internal fixation of femoral neck fractures in children: a systematic review and meta-analysis

Traumatic injuries of the immature hip and pelvis

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