Badawy Mahmoud, Sadek Sami Ibrahim, Abdelwahab Ahmed Mohamed, Algohiny Ibrahim Abdellatif
Zagazig University, Menia El-Qamh, Sharkia, 44111, Egypt.
Zagazig University, Zagazig, 7510001, Egypt.
J Orthop Surg Res. 2025 Jul 11;20(1):640. doi: 10.1186/s13018-025-06051-0.
Nonunion of pediatric femoral neck fractures is a difficult situation for orthopedic surgeons. It can result in devastating results if left untreated. The purpose of the present study was to assess and compare the results of the treatment of nonunited pediatric femoral neck fractures by closed reduction and subtrochanteric valgus osteotomy with two different fixation methods.
Seventeen patients with nonunion femoral neck fractures were treated with closed reduction, subtrochanteric osteotomy and fixation with either the proximal humerus internal locking system (PHILOS plate) (group A) (10 patients) or the Wagner technique (group B) (7 patients). The mean age of the patients was 7 years, and the mean follow-up period was 16 months.
At the end of the follow-up, all patients, the fractures were united. We did not observe any cases of implant failure. There was a statistically significant improvement in the neck shaft angle in both groups from 88.70 ± 3.36 to 129.35 ± 7.34 in group A and from 87 ± 1.91 to 126.78 ± 4.06 in group B. Regarding the clinical outcome and according to the Ratliff concept, half of the cases were good in group A and 57.1% were good in group B. There was no statistically significant difference between the groups regarding time to union, degree of coxa vara correction or the Ratliff concept.
Both the PHILOS plate and the Wagner technique offer good stable fixation options for nonunited pediatric femoral neck fractures.
小儿股骨颈骨折不愈合对骨科医生来说是个棘手的情况。如果不治疗，可能会导致灾难性后果。本研究的目的是评估和比较采用两种不同固定方法的闭合复位及转子下外翻截骨术治疗小儿股骨颈骨折不愈合的效果。
17例股骨颈骨折不愈合患者接受了闭合复位、转子下截骨术，并用近端肱骨内锁定系统（PHILOS钢板）（A组）（10例患者）或瓦格纳技术（B组）（7例患者）进行固定。患者的平均年龄为7岁，平均随访期为16个月。
随访结束时，所有患者骨折均愈合。我们未观察到任何植入物失败的病例。两组的颈干角均有统计学意义的改善，A组从88.70±3.36改善至129.35±7.34，B组从87±1.91改善至126.78±4.06。关于临床结果，根据拉特利夫概念，A组一半的病例结果良好，B组为57.1%。两组在愈合时间、髋内翻矫正程度或拉特利夫概念方面无统计学显著差异。
PHILOS钢板和瓦格纳技术均为小儿股骨颈骨折不愈合提供了良好的稳定固定选择。
