Wentao T Wang1, Yiqiang Q Li2, Yueming M Guo3, Ming Li4, Haibo B Mei5, Jingfan F Shao6, Zhu Xiong7, Jin Li8, Federico Canavese9, Shunyou Y Chen1. 1. Pediatric Orthopedic Surgery Department, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China. 2. Pediatric Orthopedic Surgery Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China. 3. Foshan Hospital of Traditional Chinese Medicine, Foshan, China. 4. Children's Hospital of Chongqing Medical University, Chongqing, China. 5. Department of Pediatric Orthopaedics, Hunan Children's Hospital, Changsha, China. 6. Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China. 7. Pediatric Orthopedic Surgery Department, Shenzhen Children's Hospital, Shenzhen, China. 8. Wuhan Union Hospital, Wuhan, China. 9. University Hospital Estaing, Clermont-Ferrand, France.
Abstract
AIMS: The aim of this study was to clarify the factors that predict the development of avascular necrosis (AVN) of the femoral head in children with a fracture of the femoral neck. PATIENTS AND METHODS: We retrospectively reviewed 239 children with a mean age of 10.0 years (sd 3.9) who underwent surgical treatment for a femoral neck fracture. Risk factors were recorded, including age, sex, laterality, mechanism of injury, initial displacement, the type of fracture, the time to reduction, and the method and quality of reduction. AVN of the femoral head was assessed on radiographs. Logistic regression analysis was used to evaluate the independent risk factors for AVN. Chi-squared tests and Student's t-tests were used for subgroup analyses to determine the risk factors for AVN. RESULTS: We found that age (p = 0.006) and initial displacement (p = 0.001) were significant independent risk factors. Receiver operating characteristic (ROC) curve analysis indicated that 12 years of age was the cut-off for increasing the rate of AVN. Severe initial displacement (p = 0.021) and poor quality of reduction (p = 0.022) significantly increased the rate of AVN in patients aged 12 years or greater, while in those aged less than 12 years, the rate of AVN significantly increased only with initial displacement (p = 0.048). A poor reduction significantly increased the rate of AVN in patients treated by closed reduction (p = 0.026); screw and plate fixation was preferable to cannulated screw or Kirschner wire (K-wire) fixation for decreasing the rate of AVN in patients treated by open reduction (p = 0.034). CONCLUSION: The rate of AVN increases with age, especially in patients aged 12 years or greater, and with the severity of displacement. In patients treated by closed reduction, anatomical reduction helps to decrease the rate of AVN, while in those treated by open reduction, screw and plate fixation was preferable to fixation using cannulated screws or K-wires. Cite this article: Bone Joint J 2019;101-B:1160-1167.
AIMS: The aim of this study was to clarify the factors that predict the development of avascular necrosis (AVN) of the femoral head in children with a fracture of the femoral neck. PATIENTS AND METHODS: We retrospectively reviewed 239 children with a mean age of 10.0 years (sd 3.9) who underwent surgical treatment for a femoral neck fracture. Risk factors were recorded, including age, sex, laterality, mechanism of injury, initial displacement, the type of fracture, the time to reduction, and the method and quality of reduction. AVN of the femoral head was assessed on radiographs. Logistic regression analysis was used to evaluate the independent risk factors for AVN. Chi-squared tests and Student's t-tests were used for subgroup analyses to determine the risk factors for AVN. RESULTS: We found that age (p = 0.006) and initial displacement (p = 0.001) were significant independent risk factors. Receiver operating characteristic (ROC) curve analysis indicated that 12 years of age was the cut-off for increasing the rate of AVN. Severe initial displacement (p = 0.021) and poor quality of reduction (p = 0.022) significantly increased the rate of AVN in patients aged 12 years or greater, while in those aged less than 12 years, the rate of AVN significantly increased only with initial displacement (p = 0.048). A poor reduction significantly increased the rate of AVN in patients treated by closed reduction (p = 0.026); screw and plate fixation was preferable to cannulated screw or Kirschner wire (K-wire) fixation for decreasing the rate of AVN in patients treated by open reduction (p = 0.034). CONCLUSION: The rate of AVN increases with age, especially in patients aged 12 years or greater, and with the severity of displacement. In patients treated by closed reduction, anatomical reduction helps to decrease the rate of AVN, while in those treated by open reduction, screw and plate fixation was preferable to fixation using cannulated screws or K-wires. Cite this article: Bone Joint J 2019;101-B:1160-1167.
Authors: Filippo Migliorini; Gerardo La Padula; Francesco Oliva; Ernesto Torsiello; Frank Hildebrand; Nicola Maffulli Journal: Life (Basel) Date: 2022-01-26
Authors: Wojciech Konarski; Tomasz Poboży; Martyna Hordowicz; Andrzej Śliwczyński; Ireneusz Kotela; Jan Krakowiak; Andrzej Kotela Journal: Int J Environ Res Public Health Date: 2022-07-29 Impact factor: 4.614