Department of Pediatric Orthopedics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Yangpu District, Shanghai, 200092, China.
Department of Pediatric Orthopedics, National Children's Medical center & Children's Hospital of Fudan University, 379 Wanyuan Road, Minhang District, Shanghai, China.
J Orthop Surg Res. 2020 Feb 19;15(1):58. doi: 10.1186/s13018-020-01587-9.
Pediatric femoral neck fracture is a rare injury but yields frequent complications. However, there is a paucity of data regarding the risk factors for these complications.
The present article reports the rate of complications after femoral neck fracture in pediatric patients and investigates the possible risk factors.
We retrospectively reviewed 44 children (mean age of 9.0 years, range from 2 to 14 years) who were surgically treated for femoral neck fracture in a single trauma center with a mean follow-up of 57.75 months (range from 11 to 224 months). Related clinical factors were recorded and analyzed by multivariable logistic regression.
Fracture displacement or Delbet-type fracture had no relation to the injury mechanism. However, younger children experienced severe trauma, combined injury, and low fracture location more than older individuals did. Children with combined injuries were more likely to have a longer waiting time for surgical reduction. Common complications included avascular necrosis (AVN) in 14 cases, nonunion of fracture in 2 cases, coxa vara in 4 cases, and premature physeal closure (PPC) in 7 cases. Only the Delbet type was an independent predictor of AVN (OR = 0.14, p = 0.030). Inadequate reduction was associated with higher rates of coxa vara (OR = 33.19, p = 0.032). Epiphysis penetration in children younger than 10 years old increased the rate of PPC (p = 0.032). No significant risk factor was found for fracture nonunion.
For femoral neck fracture in pediatric patients, both the injury mechanism and fracture characteristics have age-related distributions. Early reduction should be carried out as early as possible based on the safe condition of the child, but for younger children, transepiphyseal fixation should be avoided. AVN may be intrinsic to injury characteristics rather than resulting from the choice of treatment mode.
儿童股骨颈骨折较为少见，但常合并多种并发症。然而，目前关于这些并发症危险因素的研究较少。
本研究报道了儿童股骨颈骨折的并发症发生率，并探讨了可能的危险因素。
我们回顾性分析了在单中心接受手术治疗的 44 例儿童股骨颈骨折患者（平均年龄 9.0 岁，214 岁）的临床资料，平均随访时间为 57.75 个月（11224 个月）。记录相关临床资料，并采用多变量逻辑回归分析。
骨折移位或 Delbet 型骨折与受伤机制无关。然而，年龄较小的患儿更容易遭受严重创伤、合并损伤和较低的骨折部位。合并损伤的患儿更有可能需要较长的手术复位等待时间。常见的并发症包括 14 例股骨头缺血性坏死（AVN）、2 例骨折不愈合、4 例髋内翻和 7 例骺早闭。仅 Delbet 型是 AVN 的独立预测因子（OR=0.14，p=0.030）。复位不良与髋内翻发生率增加相关（OR=33.19，p=0.032）。10 岁以下患儿骨骺穿透增加了骺早闭的发生率（p=0.032）。未发现骨折不愈合的明显危险因素。
对于儿童股骨颈骨折，受伤机制和骨折特征均具有年龄相关性。在儿童安全的情况下，应尽早进行早期复位，但对于年龄较小的患儿，应避免经骺固定。AVN 可能与损伤特征有关，而不是与治疗方式的选择有关。
