Abstract
BackgroundAvascular necrosis (AVN) after pediatric femoral neck fracture (PFNF) showed poor prognosis, but its clinical and radiographic characteristics remained unclear.MethodsA systematic review and a retrospective study were performed to evaluate the clinical and radiographic characteristics of patients with AVN after PFNF.ResultsA total of 686 patients with PFNF and 203 patients with AVN from 21 articles were analyzed. Ratliff’s classification was used in 178 patients, with types I, II, and III AVN accounting for 58.4%, 25.3%, and 16.3%, respectively. Ratliff’s assessment was used in 147 patients, of whom 88.4% had an unsatisfactory prognosis. In retrospective study, 115 patients with a mean age of 13.6 ± 2.0 years were included. The mean interval between AVN and PFNF was 13.7 ± 9.5 months. At the time of diagnosis, 59.1% cases were symptomatic and 65.2% progressed to collapsed stage. Fifty (43.5%), 61 (53.0%), and 4 patients (3.5%) were defined as types I, II, and III , respectively, via Ratliff’s classification. Thirteen (11.3%), 40 (34.8%), and 62 patients (53.9%) showed types A/B, C1, and C2 disease, respectively, via the JIC classification. Multivariate analysis demonstrated a strong relation between collapsed stage and symptomatic cases (OR = 6.25, 95% CI = 2.39–16.36) and JIC classification (OR = 3.41, 95% CI = 1.62–7.17).ConclusionAVN after PFNF showed a tendency toward extensive necrotic lesions, presumably resulting in a rapid progression of femoral head collapse. And the symptoms and the JIC classification are other two risk factors of collapse progression.
Highlights
Pediatric femoral neck fractures (PFNFs) are rare but devastating injuries that are mostly induced by highenergy trauma in children and adolescents, with an incidence of less than 1% [1, 2]
Avascular necrosis (AVN) is the most common complication that occurs after PFNF, resulting in poor prognosis that is debilitating and potentially disabling in young populations
Selection criteria The inclusion criteria were as follows: (1) age was less than 19 years; (2) a definite history of femoral neck fractures was confirmed by imaging; (3) complications including avascular necrosis were described; and (4) the Ratliff classification was used to assess the degree of avascular necrosis, or the prognosis of patients with avascular necrosis was assessed by the Ratliff criteria [2], and the corresponding data were recorded in detail
Summary
Pediatric femoral neck fractures (PFNFs) are rare but devastating injuries that are mostly induced by highenergy trauma in children and adolescents, with an incidence of less than 1% [1, 2]. Avascular necrosis (AVN) is the most common complication that occurs after PFNF, resulting in poor prognosis that is debilitating and potentially disabling in young populations. Accumulating evidence-based medical research has confirmed the high incidence of AVN after PFNF. A similar outcome, an incidence of 24.5%, was confirmed repeatedly in a review of 239 cases of PFNF in 2019 [4]. The clinical and radiographic characteristics of AVN after PFNF remain foreign to most orthopedic surgeons because of the rare incidence of primary injury. Avascular necrosis (AVN) after pediatric femoral neck fracture (PFNF) showed poor prognosis, but its clinical and radiographic characteristics remained unclear
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