Outcomes of Pediatric Femoral Neck Fractures: Impact of Reduction Quality and Age

Yıl 2025, Cilt: 8 Sayı: 3, 355 - 358, 30.09.2025

Mehmet Yiğit Gökmen , Ahmet Rüçhan Yüce , Mesut Uluöz , Ozhan Pazarcı

Öz

Aim: Pediatric femoral neck fractures are extremely rare but carry a high risk of complications such as avascular necrosis (AVN), nonunion, and coxa vara. This study aimed to evaluate clinical and radiological outcomes and to identify prognostic factors associated with adverse events.
Materials and Methods: A retrospective cohort of 87 patients (aged 1–16 years) with femoral neck fractures treated at a tertiary trauma center between January 2017 and July 2022 was analyzed. Demographic, clinical, radiological, and operative data were reviewed. Surgical delay was categorized as ≤24 hours or >24 hours, and reduction quality was graded. Outcomes included union time, AVN, nonunion, coxa vara, and revision surgery. Group comparisons were made using appropriate parametric or non-parametric tests for continuous variables and Chi-square or Fisher’s exact tests for categorical variables.
Results: The mean age was 9.5 years, and 66.7% of patients were male. Most fractures were Delbet type II or III. Definitive fixation within 24 hours was achieved in 82.8% of cases. The overall complication rate was 17.2%, including nonunion (6.9%), coxa vara (3.4%), and AVN (3.4%). Surgical delay beyond 24 hours was significantly associated with nonunion (p = 0.03), while poor reduction quality correlated with coxa vara (p = 0.04). Two patients (2.3%) required revision surgery due to implant failure.
Conclusion: Surgical delay and poor reduction quality were the strongest predictors of adverse outcomes. Early fixation within 24 hours and meticulous anatomical reduction are essential to minimize complications in this rare but high-stakes pediatric injury.

Anahtar Kelimeler

Femur neck fracture , children , necrosis of the femoral head , fracture healing , treatment outcome

Etik Beyan

Ethical approval was obtained from the Clinical Research Ethics Committee of Adana City Training and Research Hospital (Meeting No: 107, Approval No: 1981, Date: June 9, 2022). The study was conducted in compliance with the Declaration of Helsinki, and informed consent for data use was provided by parents or legal guardians.

Destekleyen Kurum

The authors received no financial support for the research, authorship, and/or publication of this article.

Teşekkür

Not applicable..

Pediatrik Femur Boynu Kırıklarının Sonuçları: Redüksiyon Kalitesi ve Yaşın Etkisi

Öz

Amaç: Pediyatrik femur boyun kırıkları son derece nadir görülmesine rağmen avasküler nekroz (AVN), kaynamama ve coxa vara gibi ciddi komplikasyon riskleri taşır. Bu çalışmanın amacı klinik ve radyolojik sonuçları değerlendirmek ve olumsuz sonuçlarla ilişkili prognostik faktörleri belirlemektir.
Materyal ve Metot: Ocak 2017 ile Temmuz 2022 tarihleri arasında bir üçüncü basamak travma merkezinde tedavi gören 87 hasta (1-16 yaş) femur boyun kırığı retrospektif kohort analizi yapılmıştır. Demografik, klinik, radyolojik ve ameliyat verileri incelenmiştir. Ameliyat gecikmesi ≤24 saat veya >24 saat olarak sınıflandırılmış ve redüksiyon kalitesi derecelendirilmiştir. Sonuçlar arasında kaynama süresi, AVN, kaynamama, coxa vara ve revizyon ameliyatı yer almıştır. Gruplar arası karşılaştırmalar, sürekli değişkenler için uygun parametrik veya parametrik olmayan testler ve kategorik değişkenler için Ki-kare veya Fisher'in kesin testleri kullanılarak yapılmıştır.
Bulgular: Ortalama yaş 9,5 yıl olup, hastaların %66,7’si erkekti. En sık Delbet tip II ve III kırıklar izlendi. Olguların %82,8’inde 24 saat içinde kesin fiksasyon yapıldı. Genel komplikasyon oranı %17,2 idi; en sık kaynamama (%6,9), coxa vara (%3,4) ve AVN (%3,4) görüldü. Cerrahi gecikme (>24 saat) kaynamama ile (p = 0,03), kötü redüksiyon ise coxa vara ile (p = 0,04) anlamlı ilişkili bulundu. İki hastada (%2,3) implant yetmezliği nedeniyle revizyon cerrahisi uygulandı.
Sonuç: Cerrahi gecikme ve yetersiz redüksiyon kalitesi, olumsuz sonuçların en güçlü belirleyicileriydi. Bu nadir ancak riskli pediatrik yaralanmada komplikasyonları en aza indirmek için 24 saat içinde erken fiksasyon ve titiz anatomik redüksiyon esastır.

Anahtar Kelimeler

Femur boynu kırığı , çocuklar , femur başı nekrozu , kırık iyileşmesi , tedavi sonucu

Kaynakça

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