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Taşcı M, Başak F, Kemah B, Söylemez MS. Analysis of influential factors on surgical outcomes in pediatric femur neck fractures: a single-institution retrospective study. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02584-x. [PMID: 38951157 DOI: 10.1007/s00068-024-02584-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 06/14/2024] [Indexed: 07/03/2024]
Abstract
AIM This retrospective study aimed to evaluate surgical outcomes and identify influential factors in pediatric femoral neck fractures. MATERIALS AND METHODS A total of 25 hips from 23 pediatric patients who underwent surgical intervention for femoral neck fractures were included. Data encompassing patient demographics, fracture types, surgical techniques, complications, and follow-up outcomes were analyzed retrospectively. Factors such as fracture displacement, timing of surgery, fixation methods, and reduction quality were assessed concerning postoperative complications. RESULTS Falling from a height accounted for 48% of the trauma mechanisms, and avascular necrosis (AVN) was the most prevalent complication (4 hips). Although fracture displacement, bad reduction quality, and delayed surgery were more common among complicated cases, statistical significance was not attained. The study noted an association between presence of avascular necrosis and worse clinical results(rho: 0.428, p: 0.05, CI: 95%). CONCLUSION Surgical treatment yielded favorable clinical outcomes; however, limitations due to the study's retrospective design, limited sample size, and single-center approach underscore the necessity for larger multicenter studies. Our findings emphasize the need for comprehensive investigations to better understand and manage pediatric femoral neck fractures, especially regarding factors influencing AVN and long-term outcomes.
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Affiliation(s)
- Murat Taşcı
- Department of Orthopaedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Türkiye.
| | - Furkan Başak
- Department of Orthopaedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Türkiye
| | - Bahattin Kemah
- Department of Orthopaedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Türkiye
| | - Mehmet Salih Söylemez
- Department of Orthopaedics and Traumatology, Umraniye Training and Research Hospital, Istanbul, Türkiye
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Regmi A, Singh V, Bandhu Niraula B, Gowda AKS, Bansal S, Gowda R, Sharma C, Barman S. Outcome of early versus delayed presentation of proximal femur fractures in children: A prospective cohort study. Orthop Traumatol Surg Res 2024; 110:103840. [PMID: 38360173 DOI: 10.1016/j.otsr.2024.103840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/02/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE We hypothesized that the exact time of fixation of paediatric proximal femur fractures will have an effect on the ultimate clinical and radiological outcome. This article aimed to compare the clinical-radiological outcomes in paediatric proximal femur fractures having early and delayed presentation. METHODOLOGY A prospective cohort study was conducted from January 2019 to November 2022 in patients of age of 5 to 16 years presented with proximal femur fracture and divided into two groups: group A: early presentation, presented <48hours of injury; group B: delayed presentation, presented >48hours of injury. Patients underwent internal fixation treatment modality and followed up to assess clinical outcomes and radiological outcomes, and final outcome was assessed as per Ratliff's criteria. RESULTS In the study of 44 patients, 72.72% were male, and 27.27% were female, with male-to-female ratio to be 2.6:1. The commonest mode of injury was fall from height accounting for 52.27% followed by road traffic accidents (RTA) in 38.63%. The most common fracture type observed was Delbet type II, which was observed in 43.18%. There was significant shorter duration of surgery in group A (p-value=0.013), VAS score (p=0.045), and limb length discrepancy (p=0.022). Also, there was a statistical difference in AVN (p-value=0.0295) and growth disturbance (p-value=0.0394) between two groups. Also, there was statistically significant difference between Ratliff's criteria two groups (p-value=0.030). CONCLUSION Early presentation has shorter duration of surgery, less VAS score at final follow-up, and less limb length discrepancy, less development of complications like avascular necrosis of the femoral head, and growth disturbance. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Anil Regmi
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, 249203, India
| | - Vivek Singh
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, 249203, India.
| | | | - Aditya K S Gowda
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, 249203, India
| | - Shivam Bansal
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, 249203, India
| | - Rohan Gowda
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, 249203, India
| | - Cury Sharma
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, 249203, India
| | - Saptarshi Barman
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, 249203, India
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Kumar I, Ahmed W, Roshan R, Kumar S, Bhadani JS. Traumatic bilateral neck of femur fracture in paediatric age: A case report and review of literature. Med J Armed Forces India 2023; 79:S307-S310. [PMID: 38144665 PMCID: PMC10746796 DOI: 10.1016/j.mjafi.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/13/2022] [Indexed: 10/18/2022] Open
Abstract
Bilateral femoral neck fractures are rare, and only a few cases have been reported following major trauma in children. An 8-year-old male patient presented with pain both hips and inability to bear weight on his lower limbs, four days after he fell through a roof while playing. The anteroposterior pelvic radiograph showed a displaced transcervical fracture of the right femoral neck and an undisplaced transcervical fracture of the left femoral neck. Operative fixation of both hips with cannulated cancellous screws done on the 5th day of injury led to a successful outcome. This case is presented due to its rarity and successful outcome despite a late presentation.
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Affiliation(s)
- Indrajeet Kumar
- Assistant Professor (Orthopaedics), Indira Gandhi Institute of Medical Science, Sheikhpura, Patna, Bihar, India
| | - Wasim Ahmed
- Associate Professor (Orthopaedics), Indira Gandhi Institute of Medical Science, Sheikhpura, Patna, Bihar, India
| | - Reetesh Roshan
- Junior Resident (Orthopaedics), Indira Gandhi Institute of Medical Science, Sheikhpura, Patna, Bihar, India
| | - Santosh Kumar
- Professor & Head (Orthopaedics), Indira Gandhi Institute of Medical Science, Sheikhpura, Patna, Bihar, India
| | - Janki Sharan Bhadani
- Senior Resident (Orthopaedics), Indira Gandhi Institute of Medical Science, Sheikhpura, Patna, Bihar, India
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Pandey RA, Garg L. Bilateral Non-traumatic Neglected Femoral Neck Fracture in a Healthy Adolescent: A Case Report and Review of Literature. J Orthop Case Rep 2023; 13:105-110. [PMID: 37885626 PMCID: PMC10599381 DOI: 10.13107/jocr.2023.v13.i10.3954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/12/2023] [Indexed: 10/28/2023] Open
Abstract
Introduction Bilateral femoral neck fracture in children is uncommon and is extremely rare in the absence of significant injury or any underlying systemic and local bone disease. Diagnosis in these healthy children is usually delayed due to the presence of mild symptoms and lack of suspicion for a fracture. Case Report We report a case of 13-year-old girl with a bilateral neck of femur fracture without any history of trauma or any underlying systemic or local disease. The child presented to us 6 months after the onset of symptoms and was managed by osteosynthesis and valgus intertrochanteric osteotomy. The fractures on both sides healed satisfactorily without any evidence of avascular necrosis of the femoral head. However, nonunion of the intertrochanteric osteotomy was observed on the left side. It was subsequently managed by open reduction and bone grafting and healed satisfactorily thereafter. The relevant literature about this rare case has been discussed. Conclusion Management of late presenting fractured neck femur is more complex and often needs more invasive procedures. Besides, it is known to increase the risk of complications and compromise the treatment outcome. Hence, it is important to realize the possibility of a fracture neck femur in an otherwise normal child and such children should be evaluated and treated at the earliest for a better outcome.
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Affiliation(s)
- Ritesh Arvind Pandey
- Department of Orthopaedics, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Lakshay Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, Patna, Bihar, India
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Söylemez MS, Bingöl İ, Yaşar NE, Dumlupinar E, Ayvali MO, Ata N, Ülgü MM, Birinci Ş, Özdemir G, Aslantürk O. Epidemiology and demographics of pediatric proximal femur fractures in Türkiye: results from a government-based health registry. J Pediatr Orthop B 2023:01202412-990000000-00148. [PMID: 37678323 DOI: 10.1097/bpb.0000000000001127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
We evaluate the epidemiology and incidence of pediatric proximal femur fractures, treatment trends among different hospital levels, and complication rates among different treatment modalities by examining a national health registry in Türkiye. The health records of individuals aged ≤16 years admitted to public, private, and university hospitals were collected via the e-health database of the Turkish Ministry of Health. A total of 2388 children treated for proximal femur fractures from 2016 to 2021 with at least 2 years of follow-up were included in the study. While 2033 (85.1%) patients were treated with closed reduction and spica casts, 355 (14.8%) were operated on. Mean age was 8.603 ± 5.11 years. Male incidence was 2-fold greater compared to female patients (36.4% female and 63.6% male patients; P < 0.001). The frequency of cases was significantly increased in the age groups of 3-4 and 13-16 years. Comorbidities causing limited ambulation were detected in 6.5% of all cases, and 163 (8.0%) patients in the conservative group and 98 (27.6%) patients in the surgery group had at least one complication. The incidence was 0.45 per 100 000 children aged ≤16 years. This study reports the largest patient cohort to date, providing evidence on the epidemiology and incidence of pediatric proximal femur fractures using health registry data. We have found that the most common treatment modality for proximal femur fractures is closed reduction with spica casts. The rate of avascular necrosis is similar among patients treated surgically and those treated conservatively.
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Affiliation(s)
- Mehmet Salih Söylemez
- Umraniye Training and Research Hospital, Department of Orthopedics and Traumatology, Istanbul
| | - İzzet Bingöl
- Health Sciences University, Faculty of Medicine, Ankara Oncology Training and Research Hospital
| | - Niyazi Erdem Yaşar
- Health Sciences University, Ankara Bilkent City Hospital, Department of Orthopedics and Traumatology
| | - Ebru Dumlupinar
- Ankara University, Faculty of Medicine, Department of Biostatistics
| | | | - Naim Ata
- Ministry of Health, General Directorate of Health Information Systems
| | - M Mahir Ülgü
- Ministry of Health, General Directorate of Health Information Systems
| | | | - Güzelali Özdemir
- Health Sciences University, Faculty of Medicine, Ankara Bilkent City Hospital, Department of Orthopedics and Traumatology, Ankara and
| | - Okan Aslantürk
- Inonu University, Faculty of Medicine, Department of Orthopedics and Traumatology, Malatya, Türkiye
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Lim EJ, Kim BS, Kim M, Shon HC, Kim CH. Open reduction versus closed reduction in internal fixation of displaced femoral neck fracture in children: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:49. [PMID: 36650541 PMCID: PMC9843841 DOI: 10.1186/s13018-023-03525-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The quality of reduction is an important factor affecting clinical outcomes for displaced femoral neck fractures (FNFs). However, concerns remain about the invasiveness of open reduction and internal fixation (ORIF) as compared to that of closed reduction and internal fixation (CRIF), and the choice between ORIF and CRIF as an optimal treatment strategy for displaced pediatric FNF remains controversial. MATERIALS AND METHODS MEDLINE, Embase, and the Cochrane Library were systematically searched for studies published up to December 22, 2022, that compared ORIF and CRIF techniques for treating FNF in children. Pooled analysis identified differences in surgical outcomes between ORIF and CRIF, especially regarding postoperative complications, such as osteonecrosis of the femoral head (ONFH), nonunion, coxa vara deformity, leg-length discrepancy LLD, and premature physeal closure (PPC). RESULTS We included 15 studies with 635 pediatric FNF cases in our review. Of these, 324 and 311 were treated with ORIF and CRIF, respectively. The pooled analysis revealed that no significant differences existed between each reduction technique for ONFH (odds ratio [OR] = 0.89; 95% confidence interval [CI] 0.51-1.56; P = 0.69), nonunion (OR = 0.51; 95% CI 0.18-1.47; P = 0.21), coxa vara deformity (OR = 0.58; 95% CI 0.20-1.72; P = 0.33), LLD (OR = 0.57; 95% CI 0.18-1.82; P = 0.35), and PPC (OR = 0.72; 95% CI 0.11-4.92; P = 0.74). CONCLUSIONS Despite concerns about the invasiveness of ORIF, no differences in complications exist between ORIF and CRIF after FNF in children. Therefore, we believe that ORIF should be performed in FNF when the fracture is irreducible by closed manner.
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Affiliation(s)
- Eic Ju Lim
- grid.254229.a0000 0000 9611 0917Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Boo-Seop Kim
- grid.254224.70000 0001 0789 9563Department of Orthopaedic Surgery, Hyundae General Hospital, Chung-Ang University College of Medicine, Namyangju-Si, Kyunggi-Do Republic of Korea
| | - Minboo Kim
- grid.254229.a0000 0000 9611 0917Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Hyun-Chul Shon
- grid.254229.a0000 0000 9611 0917Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Chul-Ho Kim
- grid.267370.70000 0004 0533 4667Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, Republic of Korea ,grid.254224.70000 0001 0789 9563Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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Tsutsumi R, Mammoto T. Pediatric pathological subtrochanteric fracture treated with an adult proximal humerus polyaxial locking plate: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221093112. [PMID: 35465021 PMCID: PMC9021574 DOI: 10.1177/2050313x221093112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/22/2022] [Indexed: 11/16/2022] Open
Abstract
Pediatric subtrochanteric fractures are relatively rare. There are some surgical options with various plate techniques. Here, we report the first description of a pediatric pathological subtrochanteric fracture treated with an adult proximal humerus polyaxial locking plate and describe the good clinical outcomes achieved. A 10-year-old boy had a pathological subtrochanteric fracture. A non-contact bridging proximal humerus osteosynthesis plate was used. Although this is designed for the adult proximal humerus, its size and shape were considered to fit the pediatric proximal femur. In addition, this is a polyaxial locking plate with a choice of screw insertion directions. During surgery, it was possible to determine an appropriate plate installation position and screw direction in consideration of the location of pathological lesions, the bone shape, and the femoral neck angle. Twelve months postoperatively, the fracture was healed, and pathological lesion consolidated without obvious growth failure.
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Affiliation(s)
- Ryosuke Tsutsumi
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, University of Tsukuba, Mito, Japan
| | - Takeo Mammoto
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, University of Tsukuba, Mito, Japan
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