Stone Joseph D, Hill Mary K, Pan Zhaoxing, Novais Eduardo N
Orthopedics. 2015 Nov;38(11):e983-90. doi: 10.3928/01477447-20151020-06.
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.
小儿股骨颈骨折是一种罕见的损伤，与股骨头坏死的高风险相关。本研究比较了接受切开复位内固定（ORIF）或闭合复位内固定（CRIF）治疗的完全移位股骨颈骨折的小儿患者。在获得机构审查委员会批准后，作者确定了2003年至2012年间接受股骨颈骨折治疗的53例患者。纳入标准如下：（1）诊断为完全移位的股骨颈骨折，无解剖皮质接触；（2）年龄至少4岁；（3）临床/影像学随访至少1年。对病历和X线片进行回顾性分析。本研究排除了16例骨折未完全移位的患者、4例不在符合条件年龄范围内的患者、1例X线片不足的患者以及10例随访不足的患者。在纳入的22例患者中，6例接受了切开复位内固定治疗，16例接受了闭合复位内固定治疗。治疗组采用Fisher精确检验比较分类结局数据，采用Wilcoxon秩和检验比较连续变量。闭合复位内固定后（50%）股骨头坏死的发生率显著高于切开复位内固定后（0%）（P = 0.051）。此外，接受切开复位内固定的患者复位质量更高（P = 0.009），解剖愈合率更高（P = 0.046），并发症比接受闭合复位内固定的患者更少（P = 0.009）。切开复位内固定后发生主要并发症的髋关节明显少于闭合复位内固定后（P = 0.015）。根据Ratliff对最终结果的评估，两组之间未见显著差异（P = 0.477）。与接受闭合复位内固定治疗的患者相比，接受切开复位内固定治疗的完全移位小儿股骨颈骨折患者复位质量显著更高，并发症更少，包括股骨头坏死。
