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Analysis of influential factors on surgical outcomes in pediatric femur neck fractures: a single-institution retrospective study

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Abstract  

Aim

This retrospective study aimed to evaluate surgical outcomes and identify influential factors in pediatric femoral neck fractures.

Materials and methods

A total of 25 hips from 23 pediatric patients who underwent surgical intervention for femoral neck fractures were included. Data encompassing patient demographics, fracture types, surgical techniques, complications, and follow-up outcomes were analyzed retrospectively. Factors such as fracture displacement, timing of surgery, fixation methods, and reduction quality were assessed concerning postoperative complications.

Results

Falling from a height accounted for 48% of the trauma mechanisms, and avascular necrosis (AVN) was the most prevalent complication (4 hips). Although fracture displacement, bad reduction quality, and delayed surgery were more common among complicated cases, statistical significance was not attained. The study noted an association between presence of avascular necrosis and worse clinical results(rho: 0.428, p: 0.05, CI: 95%).

Conclusion

Surgical treatment yielded favorable clinical outcomes; however, limitations due to the study’s retrospective design, limited sample size, and single-center approach underscore the necessity for larger multicenter studies. Our findings emphasize the need for comprehensive investigations to better understand and manage pediatric femoral neck fractures, especially regarding factors influencing AVN and long-term outcomes.

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Fig. 1

Data availability

The data is available if requested directly from corresponding author.

References

  1. Beaty JH. Fractures of the hip in children. Orthop Clin North Am. 2006;37(2):223–32. https://doi.org/10.1016/j.ocl.2005.11.003.

    Article  PubMed  Google Scholar 

  2. Colonna PC. Fractures of the neck of the femur in children. Am J Surg. 1928;6:793. https://doi.org/10.1016/S0002-9610(29)90726-1.

    Article  Google Scholar 

  3. Ratlif AH. Fractures of the neck of the femur in children. J Bone Joint Surg Br. 1962;44–B:528–42. https://doi.org/10.1302/0301-620X.44B3.528.

    Article  Google Scholar 

  4. Spence D, DiMauro JP, Miller PE, Glotzbecker MP, Hedequist DJ, Shore BJ. Osteonecrosis after femoral Neck fractures in children and adolescents: analysis of risk factors. J Pediatr Orthop. 2016;36(2):111–6. https://doi.org/10.1097/BPO.0000000000000424.

    Article  PubMed  Google Scholar 

  5. Morsy HA. Complications of fracture of the neck of the femur in children. A long-term follow-up study. Injury. 2001;32(1):45–51. https://doi.org/10.1016/s0020-1383(00)00109-1.

    Article  CAS  PubMed  Google Scholar 

  6. Inan U, Köse N, Omeroğlu H. Pediatric femur neck fractures: a retrospective analysis of 39 hips. J Child Orthop. 2009;3(4):259–64. https://doi.org/10.1007/s11832-009-0180-y.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Bukva B, Abramović D, Vrgoč G, Marinović M, Bakota B, Dučić S, Miškulin M, Brdar R, Čoklo M, Gulan G. Femoral neck fractures in children and the role of early hip decompression in final outcome. Injury. 2015;Suppl 6:S44-7. https://doi.org/10.1016/j.injury.2015.10.059.

    Article  Google Scholar 

  8. Garden R. Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br. 1961;43:647–63.

    Article  Google Scholar 

  9. Dhar SA, Ali MF, Dar TA, Sultan A, Butt MF, Kawoosa AA, Mir MR. Delayed fixation of the transcervical fracture of the neck of the femur in the pediatric population: results and complications. J Child Orthop. 2009;3(6):473–7. https://doi.org/10.1007/s11832-009-0209-2.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Mirdad T. Fractures of the neck of femur in children: an experience at the Aseer Central Hospital, Abha, Saudi Arabia. Injury. 2002;33(9):823–7. https://doi.org/10.1016/s0020-1383(02)00013-x.

    Article  PubMed  Google Scholar 

  11. Azouz EM, Karamitsos C, Reed MH, Baker L, Kozlowski K, Hoeffel JC. Types and complications of femoral neck fractures in children. Pediatr Radiol. 1993;23(6):415–20. https://doi.org/10.1007/BF02012436.

    Article  CAS  PubMed  Google Scholar 

  12. Pring M, Rang M, Wenger D. Pelvis and hip. In: Rang M, Pring M, Wenger DR, editors. Rang’s children’s fractures. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2005. pp. 165–79.

    Google Scholar 

  13. Pandey RA, John B. Current controversies in management of fracture neck femur in children: a review. J Clin Orthop Trauma. 2020;32999559(Suppl 5):S799–806. https://doi.org/10.1016/j.jcot.2020.05.029.

    Article  Google Scholar 

  14. Maeda S, Kita A, Fujii G, Funayama K, Yamada N, Kokubun S. Avascular necrosis associated with fractures of the femoral neck in children: histological evaluation of core biopsies of the femoral head. Injury. 2003;34(4):283–6. https://doi.org/10.1016/s0020-1383(02)00281-4.

    Article  CAS  PubMed  Google Scholar 

  15. Riley PM Jr, Morscher MA, Gothard MD, Riley PM Sr. Earlier time to reduction did not reduce rates of femoral head osteonecrosis in pediatric hip fractures. J Orthop Trauma. 2015;29(5):231–8. https://doi.org/10.1097/BOT.0000000000000226.

    Article  PubMed  Google Scholar 

  16. Moon ES, Mehlman CT. Risk factors for avascular necrosis after femoral neck fractures in children: 25 Cincinnati cases and meta-analysis of 360 cases. J Orthop Trauma. 2006;20(5):323–9. https://doi.org/10.1097/00005131-200605000-00005.

    Article  PubMed  Google Scholar 

  17. Leung PC, Lam SF. Long-term follow-up of children with femoral neck fractures. J Bone Joint Surg Br. 1986;68(4):537–40. https://doi.org/10.1302/0301-620X.68B4.3733826.

    Article  CAS  PubMed  Google Scholar 

  18. Astur Dda C, Arliani GG, Nascimento CL, Blumetti FC, Fonseca MJ, Dobashi ET, Pinto JA, Ishida A. Correlation between avascular necrosis and early stabilization of proximal femoral fractures in childhood. Rev Bras Ortop. 2015;17(4):426–32. https://doi.org/10.1016/S2255-4971(15)30392-X.

    Article  Google Scholar 

  19. Bali K, Sudesh P, Patel S, Kumar V, Saini U, Dhillon MS. Pediatric femoral neck fractures: our 10 years of experience. Clin Orthop Surg. 2011;3(4):302–8. https://doi.org/10.4055/cios.2011.3.4.302.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Dendane MA, Amrani A, El Alami ZF, El Medhi T, Gourinda H. Displaced femoral neck fractures in children: are complications predictable? Orthop Traumatol Surg Res. 2010;96(2):161–5. https://doi.org/10.1016/j.rcot.2010.02.004.

    Article  CAS  PubMed  Google Scholar 

  21. Qi B, Yu A, Zhang G, Yu G, Shi Y, Zhu S, Pan Z. The treatment of displaced femoral neck fractures with vascularized great trochanter periosteal flap transposition in children. Microsurgery. 2008;28(1):21–4. https://doi.org/10.1002/micr.20439.

    Article  PubMed  Google Scholar 

  22. Mitchell JI. Fracture of the neck of the femur in children. J Am Med Assoc. 1936;107:1603e1606.

    Article  Google Scholar 

  23. Song KS. Displaced fracture of the femoral neck in children: open versus closed reduction. J Bone Joint Surg [Br]. 2010;92–B:1148e1151.

    Google Scholar 

  24. Ju L, Jiang B, Lou Y, Zheng P. Delayed treatment of femoral neck fractures in 58 children: open reduction internal fixation versus closed reduction internal fixation. J Pediatr Orthop B. 2016;25(5):459–65. https://doi.org/10.1097/BPB.0000000000000339.

    Article  PubMed  Google Scholar 

  25. Stone JD, Hill MK, Pan Z, Novais EN. Open reduction of Pediatric femoral Neck fractures reduces osteonecrosis risk. Orthopedics. 2015;38(11):e983–90. https://doi.org/10.3928/01477447-20151020-06.

    Article  PubMed  Google Scholar 

  26. Varshney MK, Kumar A, Khan SA, Rastogi S. Functional and radiological outcome after delayed fixation of femoral neck fractures in pediatric patients. J Orthop Traumatol. 2009;10(4):211–6. https://doi.org/10.1007/s10195-009-0072-4.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Sankar WN, Mehlman CT. The Community Orthopaedic Surgeon taking trauma call: Pediatric femoral Neck fracture pearls and pitfalls. J Orthop Trauma. 2019;33(Suppl 8):S22–6. https://doi.org/10.1097/BOT.0000000000001541.

    Article  PubMed  Google Scholar 

  28. Davison BL, Weinstein SL. Hip fractures in children: a long-term follow-up study. J Pediatr Orthop. 1992;12(3):355–8. https://doi.org/10.1097/01241398-199205000-00014.

    Article  CAS  PubMed  Google Scholar 

  29. Yeranosian M, Horneff JG, Baldwin K, Hosalkar HS. Factors affecting the outcome of fractures of the femoral neck in children and adolescents: a systematic review. Bone Joint J. 2013;95–B(1):135–42. https://doi.org/10.1302/0301-620X.95B1.30161.

    Article  PubMed  Google Scholar 

  30. Flynn JM, Wong KL, Yeh GL, Meyer JS, Davidson RS. Displaced fractures of the hip in children: management by early operation and immobilisation in a hip spica cast. J Bone Joint Surg. 2002;ve 84-B:108e112.

    Google Scholar 

  31. Kovar FM, Strasser E, Jaindl M, Endler G, Oberleitner G. Complications following implant removal in patients with proximal femur fractures - an observational study over 16 years. Orthop Traumatol Surg Res. 2015;101(7):785–9. https://doi.org/10.1016/j.otsr.2015.07.021.

    Article  CAS  PubMed  Google Scholar 

  32. Song KS, Lee SW. Subtrochanteric femur fracture after removal of screws for femoral neck fracture in a child. Am J Orthop (Belle Mead NJ). 2015;44(1):40–2.

    PubMed  Google Scholar 

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Funding

No funding has been received for this study.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Türkiye

    Murat Taşcı, Furkan Başak, Bahattin Kemah & Mehmet Salih Söylemez

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  1. Murat Taşcı
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  2. Furkan Başak
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  3. Bahattin Kemah
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  4. Mehmet Salih Söylemez
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Contributions

MSS, MT: design of the study, statistical analysis, development of checklists, interpretation of data, writing of the article, drafting and revision of the article. FB: acquisition of data, co-writing of the article.BK: contributed to the acquisition and analysis of the data, MSS, MT; contributed to the interpretation of the data and design of the research. All authors critically revised the manuscript, agree to be fully accountable for ensuring the integrity and accuracy of the work, and read and approved the final manuscript.

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Correspondence to Murat Taşcı.

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Ethics approval

This study was conducted in accordance with the Declaration of Helsinki and received approval from local Instutional Review Board. (B.10.1.TKH.4.34.H.GP.0.01/336).

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MT.

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The authors declare no competing interests.

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Taşcı, M., Başak, F., Kemah, B. et al. Analysis of influential factors on surgical outcomes in pediatric femur neck fractures: a single-institution retrospective study. Eur J Trauma Emerg Surg (2024). https://doi.org/10.1007/s00068-024-02584-x

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