[Femoral neck fractures are rare injuries in the pediatric population]

• Restricted to UC San Diego use only

• 2012

• Yeranosian, M.

Introduction : Femoral neck fractures in the pediatric population are rare injuries, associated with high rates of complications, including avascular necrosis (AVN), nonunion, coxa vara, and premature physeal closure (PPC). The optimal treatment for these fractures is controversial, including the need for urgent surgical intervention, open reduction, and capsular decompression. To minimize poor outcomes, treatment has become more aggressive, with relatively little empirical evidence attesting to the efficacy of such measures. Methods : We performed a systematic review of the English literature for studies examining outcomes following different types of treatment for femoral neck fractures in children and adolescents using computerized databases (Pubmed, EMBASE, and Cochrane). Outcomes of interest were avascular necrosis, nonunion, coxa vara, PPC, need for revision surgery, infection, and Ratliff's criteria. We performed a meta- analysis using a Der-Simonian and Laird random effects model. Publication bias and study quality were also assessed. Results : Thirty studies constituting 935 patients (0.5-19 years old) were found. Operative treatment and open reduction (ORIF) were associated with higher rates of AVN. Delbet I and II fractures were most likely to receive ORIF. Coxa vara was lower in the operative group, while nonunion and PPC were not related to surgical intervention. Nonunion and coxa vara were unaffected by method of reduction. Capsular decompression had no effect on AVN. Good outcomes by Ratliff's criteria were associated with early intervention, but otherwise unrelated to type of treatment. Conclusion : Surgical treatment results in a more anatomic union. It is difficult to say whether or not operative treatment or type of reduction has any effect on AVN, nonunion, or PPC. This is because worse fractures were more likely to receive operative treatment. Early treatment is warranted, as our review showed an increased rate of AVN and worse outcomes when definitive treatment was delayed more than 24 hours. Capsular decompression does not appear to be clinically useful. Higher quality studies are needed to determine how to best treat this injury

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• Academic Dissertations

• Dissertations, Academic--School of Medicine. (Discipline)--UCSD

• text

Thesis (M.D.)--University of California, San Diego, 2012

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Forms part of the UCSD School of Medicine independent study projects, Class of 2012

Includes bibliographical references (p. 14-16)

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• M Yeranosian

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2020-10-22