Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES · 2025
Cannulated screw fixation in pediatric femoral neck fractures: Outcomes and complication predictors.
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Talmaç Mehmet Ali, Civan Melih, Kar İlyas, Önaloğlu Yiğit
Аннотация
BACKGROUND: Pediatric femoral neck fractures (PFNFs) are rare but are associated with high complication rates due to the precarious vascularity of the femoral head. Cannulated screw fixation (CSF) is the most common surgical technique, though optimal strategies remain debated. The objective of this study was to evaluate the radiological and functional outcomes of proximal femoral neck fractures (PFNFs) treated with CSF and to identify predictors of postoperative complications.
METHODS: The retrospective study was performed of 28 patients (mean age 12.4 years; range 5-18) treated with CSF between June 2020 and December 2024. Fractures were classified using the Delbet-Colonna and Garden systems. Reduction quality was assessed radiographically, and functional outcomes were measured by the Harris Hip Score (HHS). Statistical analyses included univariate and multivariate logistic regression.
RESULTS: Radiographic union was achieved in 92.9% of patients. The overall complication rate was 42.9%, including coxa vara (17.8%), avascular necrosis (AVN, 14.3%), premature physeal closure (PPC, 10.7%), and non-union (7.1%). Patients with AVN (mean HHS 72.5) and non-union (mean HHS 70.0) had the lowest functional scores, while those with coxa vara (82.0) and PPC (85.0) maintained relatively better function. Patients without complications achieved the best outcomes (mean HHS 88.5). Multivariate analysis identified higher Garden grade (OR 4.1, p=0.038) and non-anatomical reduction (OR 3.75, p=0.046) as independent predictors. PPC was significantly associated with implant removal (p=0.003). Despite the small sample, a post-hoc power analysis based on HHS indicated approximately 85% power to detect large effects.
CONCLUSION: PFNFs remain a challenging pediatric injury with high complication rates despite surgical fixation. Precise anatomic alignment is essential to minimize complications, particularly AVN and coxa vara. Close monitoring is recommended for patients with PPC, as it may necessitate implant removal and carries a risk of hip deformity or leg length discrepancy. Larger prospective studies are needed to refine surgical strategies for this rare but clinically significant injury.
METHODS: The retrospective study was performed of 28 patients (mean age 12.4 years; range 5-18) treated with CSF between June 2020 and December 2024. Fractures were classified using the Delbet-Colonna and Garden systems. Reduction quality was assessed radiographically, and functional outcomes were measured by the Harris Hip Score (HHS). Statistical analyses included univariate and multivariate logistic regression.
RESULTS: Radiographic union was achieved in 92.9% of patients. The overall complication rate was 42.9%, including coxa vara (17.8%), avascular necrosis (AVN, 14.3%), premature physeal closure (PPC, 10.7%), and non-union (7.1%). Patients with AVN (mean HHS 72.5) and non-union (mean HHS 70.0) had the lowest functional scores, while those with coxa vara (82.0) and PPC (85.0) maintained relatively better function. Patients without complications achieved the best outcomes (mean HHS 88.5). Multivariate analysis identified higher Garden grade (OR 4.1, p=0.038) and non-anatomical reduction (OR 3.75, p=0.046) as independent predictors. PPC was significantly associated with implant removal (p=0.003). Despite the small sample, a post-hoc power analysis based on HHS indicated approximately 85% power to detect large effects.
CONCLUSION: PFNFs remain a challenging pediatric injury with high complication rates despite surgical fixation. Precise anatomic alignment is essential to minimize complications, particularly AVN and coxa vara. Close monitoring is recommended for patients with PPC, as it may necessitate implant removal and carries a risk of hip deformity or leg length discrepancy. Larger prospective studies are needed to refine surgical strategies for this rare but clinically significant injury.