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01-01-2020 | Original Paper

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

Authors: Wentao Wang, Yiqiang Li, Yueming Guo, Ming Li, Haibo Mei, Jingfan Shao, Zhu Xiong, Jin Li, Federico Canavese, Shunyou Chen, Chinese Multicenter Pediatric Orthopedic Study Group (CMPOS)

Published in: International Orthopaedics | Issue 1/2020

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; T_AP% and A_AP) and lateral (T_L% and A_L) 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 T_AP%, T_L%, A_AP, and A_L were risk factors for AVN (P < 0.05). The analysis of ROC curves found that T_AP% over 37.4% and T_L% over 29% were the cut-off values for an increased incidence of AVN; similarly, A_AP over 8° and A_L 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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Title: 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
Authors: Wentao Wang
Yiqiang Li
Yueming Guo
Ming Li
Haibo Mei
Jingfan Shao
Zhu Xiong
Jin Li
Federico Canavese
Shunyou Chen
Chinese Multicenter Pediatric Orthopedic Study Group (CMPOS)
Publication date: 01-01-2020
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 1/2020
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-019-04429-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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