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Wang W, Huang D, Xiong Z, Guo Y, Liu P, Li M, Mei H, Li Y, Canavese F, Chen S. Is there an alternative to the Delbet-Colonna classification? Introduction and reliability assessment of a new classification system for paediatric femoral neck fractures: preliminary results. INTERNATIONAL ORTHOPAEDICS 2024; 48:1507-1516. [PMID: 38081948 DOI: 10.1007/s00264-023-06051-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/23/2023] [Indexed: 05/08/2024]
Abstract
PURPOSE The purpose of this study was to introduce a new classification system for paediatric femoral neck fractures (PFNFs) and to evaluate its reliability. METHODS Two hundred and eight unilateral PFNFs (mean patient age: 9.0 ± 4.8 years) were included. Based on preoperative radiographs, the new classification system distinguished PFNFs without anterior or posterior translation (Type I), PFNFs with anterior (Type II) or posterior (Type III) translation, PFNFs with a comminuted medial or posterior column (Type IV), and subtrochanteric femoral fractures (SFFs; Type V). Radiographs were evaluated twice with an interval of two weeks by 19 raters with different specialties, experiences and geographical origins. The results were compared with a selection of 50 patient age-matched unilateral PFNFs and SFFs (mean patient age: 9.1 ± 4.9 years). These were graded twice by the same graders according to the Delbet-Colonna (D-C) classification. RESULTS Four radiologists and 15 paediatric orthopaedic surgeons from Europe and Asia graded the radiographs. Fair agreement was found between radiologists (κ = 0.296 ± 0.01) and surgeons (κ = 0.3 ± 0.005) (P = 0.17), although more experienced surgeons performed better than less experienced ones; a similar fair assessment was found for raters from Europe (κ = 0.309 ± 0.021) and Asia (κ = 0.3 ± 0.006) and for type II, III and IV fractures; the κ value in the first evaluation (0.309) was similar to that in the second evaluation (0.298). The overall κ value of the D-C classification subtypes was significantly higher (0.599 ± 0.217) than that of the new classification, 0.326 ± 0.162 (t = 3.190 P = 0.005). CONCLUSIONS The new classification system showed fair reliability relative to the D-C classification. The reliability of the new classification system was not affected by the specialty or geographic origin of the rater or the evaluation round, only by rater experience level. The concordance was worse for PFNFs with anterior or posterior translation or with a comminuted medial or posterior columns.
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Affiliation(s)
- WenTao Wang
- Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, 518107, Guangdong Province, China
| | - DianHua Huang
- Department of Pediatric Orthopedics, Fuzhou Second Hospital, Fuzhou, 350007, Fujian Province, China
| | - Zhu Xiong
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Shenzhen, 518034, Guangdong Province, China
| | - YueMing Guo
- Department of Pediatric Orthopaedics, Foshan Hospital of Traditional Chinese Medicine, Foshan, 528099, Guangdong Province, China
| | - PengRan Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
| | - Ming Li
- Department of Pediatric Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing, 400015, China
| | - HaiBo Mei
- Department of Pediatric Orthopaedics, Hunan Children's Hospital, Changsha, 410007, Hunan Province, China
| | - YiQiang Li
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, GuangZhou Medical University, Guangzhou, 510623, Guangdong Province, China
| | - Federico Canavese
- Department of Pediatric Orthopaedics, Lille University Center, Jeanne de Flandre Hospital, Avenue Eugène Avinée, 59037, Lille Cedex, France
| | - ShunYou Chen
- Department of Pediatric Orthopedics, Fuzhou Second Hospital, Fuzhou, 350007, Fujian Province, China.
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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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Wang W, Mei Q, Guo Y, He B, Mei H, Li Y, Canavese F, Chen S. The Duration of Hardware Retention After Radiologic Union of Surgically Treated Femoral Neck Fractures in Children May Predict the Aggravation or Occurrence of Avascular Necrosis of the Femoral Head or Neck After Hardware Removal. J Pediatr Orthop 2024; 44:e7-e14. [PMID: 37737685 DOI: 10.1097/bpo.0000000000002523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
BACKGROUND The incidence of aggravation or occurrence of avascular necrosis (AVN) following hardware removal in surgically treated pediatric femoral neck fractures who achieved radiologic consolidation is unknown. This study aimed to investigate the risk factors for this complication. METHODS Seventy-one pediatric (mean age: 9.8±3.9 y) were retrospectively analyzed. Risk factors (age, sex, laterality, severity of initial displacement, type of fracture, time from trauma to reduction, reduction and fixation method, quality of reduction, time required to achieve radiologic union, duration of hardware retention, presence of AVN before hardware removal and follow-up time) were recorded. The severity of AVN was assessed based on radiographs with Ratliff's classification. RESULTS Following hardware removal, the aggravation/occurrence of AVN was detected in 11 hips (15.5%). Among the 5 hips (7%) with aggravation of AVN, 1 (1.4%) with type II AVN and 3 (4.2%) with type III AVN exhibited aggravation of type I AVN, while the remaining hip (1.4%; type I) showed enlargement of the involved AVN area. Six hips (8.5%) developed AVN following hardware removal: 2 (2.8%) were classified as type I and 4 (5.6%) as type III. Receiver operating characteristic curve analysis indicated that hardware retention >7 months after union is associated with a decreased rate of aggravation or occurrence of AVN of the femoral neck or head following hardware removal. CONCLUSIONS The incidence of aggravation or occurrence of AVN following hardware removal in surgically treated pediatric femoral neck fractures is 15.5%; hardware retention >7 months after radiologic union may reduce the risk of aggravation or occurrence of AVN of the femoral neck or head postimplant removal. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- WenTao Wang
- Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University
| | - QianQian Mei
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Shenzhen
| | - YueMing Guo
- Department of Pediatric Orthopaedics, Foshan Hospital of Traditional Chinese Medicine, Foshan
| | - Bo He
- Department of Pediatric Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing
| | - HaiBo Mei
- Department of Pediatric Orthopaedics, Hunan Children's Hospital, Hunan
| | - YiQiang Li
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, GuangZhou Medical University, Guangzhou
| | - Federico Canavese
- Department of Pediatric Orthopaedics, Lille University Center, Jeanne de Flandre Hospital, Lille cedex, France
| | - ShunYou Chen
- Department of Pediatric Orthopaedics, FuZhou Second Hospital, FuZhou, China
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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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Chen H, Chen Z, Chen P, Zheng Z, Lin J. Incidence of growth disturbance after distal tibia physeal fracture in children. J Orthop Surg Res 2022; 17:529. [PMID: 36482401 PMCID: PMC9730681 DOI: 10.1186/s13018-022-03427-4] [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: 05/08/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND To analyze the growth disturbance after distal tibia physeal fracture in children. METHODS Data about children with distal tibia physeal fractures between September 2015 to September 2018 were collected, including age, gender, affected side, Salter-Harris classification, initial maximal displacement, with or without fibula fracture, open or closed reduction, the method of fixation, time to surgery, blood loss, duration of operation, and complications. Patients were placed in the growth disturbance group when leg length discrepancy was equal to or greater than 1.5 cm, or when they had more than 5 degrees of varus or valgus deformity. Others were placed in the no-growth disturbance group. RESULTS A total of 143 patients (96 boys and 47 girls) were enrolled in this study. The length of the follow-up periods averaged 29.34 ± 7.46 months (26 to 61 months). Among the total of 143 patients, the incidence of growth disturbance was 15.39% (22/143). The no-growth disturbance group consisted of 121 patients (84 boys and 37 girls), with a mean age of 11.50 ± 3.20 years, and there were 68, 52, and 1 injuries to the left, right, and bilateral sides, respectively. The average maximal displacement was 5.51 ± 3.18 mm, and 27.27% (33/121) of patients also had a fibula fracture. The growth disturbance group contained 22 patients (12 boys and 10 girls) with a mean age of 9.32 ± 3.56 years, and there were 12, 10, and 0 injuries on the left, right, and bilateral sides, respectively. The average maximal displacement was 5.77 ± 4.89 mm, and 45.45% (10/22) of patients also had a fibula fracture. There was a significant difference in age (p = 0.004) and fibula fracture (p = 0.011) between the two groups. More patients had Salter-Harris types III and IV fractures in the growth disturbance group than in the no-growth disturbance group (p = 0.043). CONCLUSIONS Children with Salter-Harris types III and IV fractures, younger children, and children with fibula fractures all have a higher incidence of growth disturbance after distal tibia physeal fractures. LEVEL OF EVIDENCE Level III-Prognostic study.
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Affiliation(s)
- Hui Chen
- grid.256112.30000 0004 1797 9307Department of Pediatric Orthopedics, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001 China ,grid.415626.20000 0004 4903 1529Department of Pediatric Orthopedics, Fujian Children’s Hospital, Fuzhou, 350011 China ,grid.490567.9Department of Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, 350007 China
| | - Zhao Chen
- grid.256112.30000 0004 1797 9307Department of Pediatric Orthopedics, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001 China ,grid.415626.20000 0004 4903 1529Department of Pediatric Orthopedics, Fujian Children’s Hospital, Fuzhou, 350011 China
| | - Peisheng Chen
- grid.490567.9Department of Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, 350007 China
| | - Zibing Zheng
- grid.256112.30000 0004 1797 9307Department of Pediatric Orthopedics, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001 China ,grid.415626.20000 0004 4903 1529Department of Pediatric Orthopedics, Fujian Children’s Hospital, Fuzhou, 350011 China
| | - Jinrun Lin
- grid.256112.30000 0004 1797 9307Department of Pediatric Orthopedics, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001 China ,grid.415626.20000 0004 4903 1529Department of Pediatric Orthopedics, Fujian Children’s Hospital, Fuzhou, 350011 China
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Wang W, Xiong Z, Zhao C, He B, Mei H, Li Y, Canavese F, Pan Y, Chen S. Do the Number, Size, and Position of Partially Threaded Screws Affect the Radiological Healing of Surgically Treated Displaced Femoral Neck Fractures? A Review of 136 Children. Medicina (B Aires) 2022; 58:medicina58091153. [PMID: 36143830 PMCID: PMC9504257 DOI: 10.3390/medicina58091153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/12/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: The quantity, size, and position of implants might affect the fracture healing process of surgically treated displaced pediatric femoral neck fractures (PFNFs). The aim of this retrospective multicenter study was to evaluate the correlation between the time needed to achieve radiological union and the number, size, and location of the partially threaded cannulated screws (PTCSs) in children with displaced PFNFs. Materials and Methods: A retrospective review of 136 children (mean age: 10.6 ± 3.8 years) with displaced PFNFs treated by two (n = 103) or three (n = 33) PTCSs was carried out. Student’s t-tests, one-way ANOVA, Cox regression analysis, and multiple linear regression analyses were performed to investigate the variables affecting the time needed to achieve radiological fracture healing according to the number, size, and position of PTCSs, as assessed on plain radiographs. Results: A total of 132 hips achieved union at an average of 3.2 ± 1.6 months after the initial surgery. The time needed to achieve union in the patients treated with two or three PTCSs was comparable (p = 0.36). Among the fractures treated by two PTCSs, the time needed to achieve union did not correlate with the size of the implant (p = 0.122), or with the angulation between the PTCSs on anterior–posterior (p = 0.257) and lateral radiographs (p = 0.547). The time needed to achieve union in the fractures that were fully compressed by the implants was similar to the partially compressed fractures (p = 0.08). Conclusions: The number, size, and position of the PTCSs do not affect the radiological healing in the children with displaced PFNFs treated surgically.
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Affiliation(s)
- Wentao Wang
- Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China
| | - Zhu Xiong
- Department of Pediatric Orthopedics, Shenzhen Children’s Hospital, Shenzhen 518034, China
| | - Chongzhi Zhao
- Department of Pediatric Orthopedics, Foshan Hospital of Traditional Chinese Medicine, Foshan 528099, China
| | - Bo He
- Department of Orthopedics, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400015, China
| | - Haibo Mei
- Department of Pediatric Orthopedics, Hunan Children’s Hospital, Changsha 410007, China
| | - Yiqiang Li
- Department of Pediatric Orthopedics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Federico Canavese
- Lille University Center, Jeanne de Flandre Hospital, Department of Pediatric Orthopaedics, Avenue Eugène Avinée, 59037 Lille, France
| | - Yuancheng Pan
- Department of Pediatric Orthopedics, Fuzhou Second Hospital, 47th Shangteng Road of Cangshan District, Fuzhou 350007, China
| | - Shunyou Chen
- Department of Pediatric Orthopedics, Fuzhou Second Hospital, 47th Shangteng Road of Cangshan District, Fuzhou 350007, China
- Correspondence: ; Tel./Fax: +86-0591-22169186
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