Başaran Serdar Hakan, Yalın Mustafa, Bayrak Alkan, Erkılınç Mehmet, Çelik Malik, Dönmez Behlül
Department of Orthopedics and Traumatology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey.
Department of Orthopedics and Traumatology, Yalova University Faculty of Medicine, Yalova, 77200, Turkey.
BMC Musculoskelet Disord. 2025 Aug 4;26(1):750. doi: 10.1186/s12891-025-09033-9.
The current study aimed to examine the short- and long-term relationship between complications and radiologic and functional outcomes in surgically treated patients with Delbet type II and type III paediatric femoral neck fractures (PFNFs).
We examined the medical records of PFNFs from 2006 to 2013. Retrospective analysis examined patient demographics, fracture types, surgical procedures, complications, and follow-up outcomes. We used Ratliff’s method for early radiological and clinical assessment of patients in the second postoperative year. At the final follow-up, Tönnis criteria and the Harris hip score were used to evaluate late findings in adulthood.
Over an average follow-up of 157.2 months, we evaluated 26 patients, with an average age of 10.7 years. Early complications included coxa breva (34.6%) and limb length discrepancy (LLD) (30.8%); late complications included osteoarthritis (OA) (23.1%) and LLD (23.1%). During the early follow-up period, avascular necrosis (AVN) was observed in 6 individuals, accounting for 23.1% of the cases. There were no cases of nonunion or infection detected in any of the patients. AVN correlated with non-anatomic reduction, poor Ratliff classification (early), lower Harris hip scores (late), and OA (late) ( < 0.05). Non-anatomic reduction was significantly correlated with all three main complications ( < 0.05).
Anatomical reduction significantly influences early and late complications following PFNF surgery. Therefore, we strongly affirm that prioritising anatomical reduction is more important than any other criterion mentioned in the literature. The AVN predicts OA and poor long-term outcomes. Coxa breva and LLD did not correlate with poor clinical outcomes or the onset of OA.
本研究旨在探讨手术治疗的德尔贝II型和III型儿童股骨颈骨折（PFNF）患者并发症与放射学及功能预后之间的短期和长期关系。
我们查阅了2006年至2013年PFNF患者的病历。回顾性分析包括患者人口统计学资料、骨折类型、手术方式、并发症及随访结果。我们采用拉特利夫方法对术后第二年的患者进行早期放射学和临床评估。在末次随访时，使用托尼斯标准和哈里斯髋关节评分评估成年后的晚期结果。
平均随访157.2个月，我们评估了26例患者，平均年龄10.7岁。早期并发症包括髋短缩（34.6%）和肢体长度差异（LLD）（30.8%）；晚期并发症包括骨关节炎（OA）（23.1%）和LLD（23.1%）。在早期随访期间，6例患者出现股骨头缺血性坏死（AVN），占病例的23.1%。所有患者均未发现骨不连或感染病例。AVN与非解剖复位、拉特利夫分类差（早期）、哈里斯髋关节评分低（晚期）及OA（晚期）相关（<0.05）。非解剖复位与所有三种主要并发症均显著相关（<0.05）。
解剖复位对PFNF手术后的早期和晚期并发症有显著影响。因此，我们强烈肯定，优先进行解剖复位比文献中提到的任何其他标准都更重要。AVN预示着OA和不良的长期预后。髋短缩和LLD与不良临床预后或OA的发生无关。
