University of Texas Health Science Center at Houston, Houston, TX.
Methodist Hospital System, Houston, TX; and.
J Orthop Trauma. 2024 Oct 1;38(10):541-546. doi: 10.1097/BOT.0000000000002872.
To identify the incidence, patient characteristics, and effectiveness of radiographic screening methods for detecting ipsilateral femoral neck and shaft fractures in pediatric and adolescent trauma patients.
Retrospective cohort study.
This study was conducted at a tertiary pediatric trauma hospital.
Patients younger than 18 years treated for a femoral shaft fracture between 2004 and 2018 were reviewed. Pathologic (metabolic bone disease or bone lesion), periprosthetic, and penetrating traumatic femoral shaft fractures were excluded.
Patient demographics, mechanisms of injury, treatment methods, and associated injuries were analyzed. Pretreatment x-rays and computed tomography (CT) scans were reviewed for the identification of ipsilateral femoral neck and shaft fractures.
Among the 840 pediatric patients included in this study, 4 patients (0.5%) sustained ipsilateral femoral neck and shaft fractures. All the femoral neck fractures were observed in adolescents (aged 13-17 years) and involved in high-energy traumas. In adolescents involved in high-energy trauma, the incidence increased to 1.7%. Pretreatment sensitivity of both x-rays and CT scans was only 50% for the detection of femoral neck fractures.
This study reveals that ipsilateral femoral neck and shaft fractures in pediatric patients are rare, occurring in adolescents involved in high-energy trauma. The findings suggest the need for a selective, rather than routine, use of CT scans based on the patient's age and the mechanism of injury. The use of alternative imaging methods such as magnetic resonance imaging should be considered to balance diagnostic accuracy while minimizing radiation exposure.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
确定影像学筛查方法在检测儿童和青少年创伤患者同侧股骨颈和股骨干骨折中的发生率、患者特征和有效性。
回顾性队列研究。
本研究在一家三级儿科创伤医院进行。
回顾 2004 年至 2018 年间因股骨干骨折接受治疗的年龄小于 18 岁的患者。排除病理性（代谢性骨病或骨病变）、假体周围和穿透性创伤性股骨干骨折。
分析患者的人口统计学特征、损伤机制、治疗方法和相关损伤。对术前 X 线和计算机断层扫描（CT）进行评估，以确定同侧股骨颈和股骨干骨折。
本研究纳入 840 例儿科患者，其中 4 例（0.5%）发生同侧股骨颈和股骨干骨折。所有股骨颈骨折均发生在青少年（13-17 岁），且均为高能量创伤。在涉及高能量创伤的青少年中，发生率增加至 1.7%。X 线和 CT 扫描术前的敏感度均仅为 50%，用于检测股骨颈骨折。
本研究表明，儿童同侧股骨颈和股骨干骨折罕见，发生在涉及高能量创伤的青少年中。结果提示需要根据患者年龄和损伤机制选择性地而非常规使用 CT 扫描。应考虑使用替代成像方法，如磁共振成像，以平衡诊断准确性，同时尽量减少辐射暴露。
预后 IV 级。请参阅作者说明，以获取完整的证据水平描述。
