Clinical efficacy of needle aspiration combined with closed reduction and internal fixation within 24-72 h in the treatment of pediatric femoral neck fracture.

BACKGROUND

Femoral neck fracture is a less common injury in childhood but carry a high risk of avascular necrosis (AVN) of the femoral head. This study aimed to assess the clinical efficacy of needle aspiration combined with closed reduction and internal fixation (CRIF) performed within 24-72 h of injury for the treatment of pediatric femoral neck fractures.

METHODS

This retrospective study enrolled 26 children with femoral neck fractures who underwent cannulated screw fixation using CRIF at our department between January 2010 and January 2014. Based on whether needle aspiration was performed after fixation, patients were stratified into two groups: the aspiration group (AG, n = 11) and the non-aspiration group (NG, n = 15). All patients were followed for a minimum of 5 years. The primary outcomes were the effects of needle aspiration and the complication of AVN. Secondary outcomes included functional outcomes assessed using Ratliff's criteria, as well as the incidence of coxa vara and non-union. According to Ratliff's criteria, a good result was defined as a "satisfactory outcome," while fair and poor results were categorized as "unsatisfactory outcomes."

RESULTS

A total of 26 patients (26 hips) were evaluated, including 14 girls and 12 boys, with a mean age of 9.6 ± 2.5 years (range, 5-14 years). No significant differences were observed between these two groups in baseline characteristics, including gender, age, affected side, type of fracture, displacement, and time to reduction. The rate of satisfactory outcomes was 81.8% in the AG group and 66.7% in the NG group (OR = 2.25, CI, 0.35-14.61, p = 0.658). AVN occurred in six cases overall, with two cases in the AG group and four in the NG group (OR=1.63, CI, 0.24-11.08, p = 1.000). Based on the Ratliff classification system for AVN, four cases were classified as grade I, one as grade II, and one as grade III. Logistic regression analysis identified reduction quality as an independent risk factor for the development of AVN (OR = 12.06, CI, 1.01-143.60, p = 0.049). There was no significant difference in the incidence of other complications between these two groups.

CONCLUSIONS

For children under 14 years of age with type II and III femoral neck fractures, needle aspiration combined with CRIF performed within 24-72 h of injury did not yield a statistically significant reduction in the risk of AVN compared with primary CRIF alone. Reduction quality was confirmed as an independent risk factor for postoperative AVN in this pediatric population.