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Initial displacement as a risk factor for avascular necrosis of the femoral head in pediatric femoral neck fractures: a review of one hundred eight cases

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Abstract

Purpose

To evaluate the correlation between avascular necrosis (AVN) and the amount (severity) and direction (translation and angulation) of initial displacement of pediatric femoral neck fractures.

Methods

We retrospectively reviewed 108 pediatric patients (mean age 10.3 ± 4.1 years) with femoral neck fractures. The amount of initial translation (T) and angulation (A) was measured on anteroposterior (AP; TAP% and AAP) and lateral (TL% and AL) radiographs. The direction of translation was determined on AP (medial or lateral) and lateral radiographs (anterior or posterior). Furthermore, the presence of a comminuted medial cortex on the AP pelvis radiograph was also recorded. Logistic regression analysis, receiver operating characteristic (ROC) curve analysis, student’s t tests, and chi-square tests were used to evaluate the correlation between AVN and the severity and direction of displacement.

Results

Twenty-eight out of 108 hips (25.9%) developed AVN of the femoral head. Logistical regression analysis indicated that TAP%, TL%, AAP, and AL were risk factors for AVN (P < 0.05). The analysis of ROC curves found that TAP% over 37.4% and TL% over 29% were the cut-off values for an increased incidence of AVN; similarly, AAP over 8° and AL over 18.6° were the cut-off values for an increased incidence of AVN. The amount of initial translation is a better predictor of AVN than angulation is; fractures with posterior translation (P = 0.002) and/or medial comminution had a significantly higher incidence of AVN (P = 0.005). The mean diagnostic accuracy of translation (74–75%) was significantly higher than that of angulation (65–66%).

Conclusions

Displacement severity and direction are important radiological parameters to be assessed in children with femoral neck fractures. Initial translation better predicts AVN than angulation does. Posterior translation and medial comminution are associated with an increased risk of AVN.

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Acknowledgments

We thank Yuancheng Pan, Xiaokun Lu, Guoxin Nan, Chongzhi Zhao, and Yaoxi Liu for the data collection.

Author information

Author notes

  1. Wentao Wang, Yiqiang Li, Yueming Guo, Ming Li and Haibo Mei contributed equally to this work.

Authors and Affiliations

  1. Department of Pediatric Orthopedics, FuZhou Second Hospital Affiliated to Xiamen University, 47th ShangTeng Road of CangShan District, FuZhou, 350007, FuJian Province, China

    Wentao Wang & Shunyou Chen

  2. Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, GuangZhou Medical University, GuangZhou, China

    Yiqiang Li

  3. Department of Pediatric Orthopedics, Foshan Hospital of Traditional Chinese Medicine, Foshan, China

    Yueming Guo

  4. Department of Pediatric Orthopedics, Children’s Hospital of Chongqing Medical University, Chongqing, China

    Ming Li

  5. Department of Pediatric Orthopedic, Hunan Children’s Hospital, Changsha, Hunan, China

    Haibo Mei

  6. Department of Pediatric Orthopedics, TongJi Hospital of TongJi Medical College Huazhong University of Science and Technology, Wuhan, China

    Jingfan Shao

  7. Department of Pediatric Orthopedics, ShenZhen Children’s Hospital, Shenzhen, China

    Zhu Xiong

  8. Department of Pediatric Orthopedics, Wuhan Union Hospital, Wuhan, China

    Jin Li

  9. Department of Pediatric Surgery, University Hospital Estaing, Clermont-Ferrand, France

    Federico Canavese

Authors
  1. Wentao Wang
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  2. Yiqiang Li
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  3. Yueming Guo
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  8. Jin Li
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  10. Shunyou Chen
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Chinese Multicenter Pediatric Orthopedic Study Group (CMPOS)

Corresponding author

Correspondence to Shunyou Chen.

Ethics declarations

The authors declare that they have no conflict of interest. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

All procedures were performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

This is a retrospective study, and an IRB approval was obtained (approval no. 20190301).

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Wang, W., Li, Y., Guo, Y. et al. Initial displacement as a risk factor for avascular necrosis of the femoral head in pediatric femoral neck fractures: a review of one hundred eight cases. International Orthopaedics (SICOT) 44, 129–139 (2020). https://doi.org/10.1007/s00264-019-04429-4

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