Early Versus Late Fixation of Paediatric Femoral Neck Fractures: A systematic review and meta-analysis

Che Mohd Hanif B. Che Mat; Abdul Razak Sulaiman; Norhayati Mohd Noor

Early Versus Late Fixation of Paediatric Femoral Neck Fractures: A systematic review and meta-analysis

dc.contributor	Department of Orthopaedics, School of Medical Science, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, MALAYSIA
dc.contributor	Department of Orthopaedics, School of Medical Science, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, MALAYSIA
dc.contributor	Family Medicine Department, School of Medical Science, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, MALAYSIA
dc.contributor.author	Che Mohd Hanif B. Che Mat
dc.contributor.author	Abdul Razak Sulaiman
dc.contributor.author	Norhayati Mohd Noor
dc.date.accessioned	2024-05-28T01:10:27Z
dc.date.available	2024-05-28T01:10:27Z
dc.description	Fractures of the femoral neck (NOF) in children are rare, making up less than 1% of all pediatric fractures. Such fractures usually result from significant trauma, such as motor vehicle accidents or falls from heights, due to the robust bone structure and thick periosteal layer in children. These fractures are associated with high rates of complications and unfavorable outcomes, largely due to the unique anatomical features and distinct blood supply in children, which differ from those in adults. The differences between fractures in children and adults stem from the dynamics of the growth plate and the blood supply to the femoral head, which change as the child grows. In children under four years, the femoral head relies on the metaphyseal vessel penetrating the growth plate, the lateral epiphyseal vessel in the retinacula, and the limited vessel in the ligamentum teres. After age four, the metaphyseal vessels diminish, and by ages four to seven, the femoral head depends almost entirely on the lateral epiphyseal vessels. By ages 14 in females and 16 in males, the blood supply becomes more injury-resistant as the physis fuses. Despite these changes, studies have found no significant link between patient age and the risk of avascular necrosis (AVN) of the femoral head following a femoral neck fracture in patients under 19 years old. Historically, these fractures have been linked to higher rates of complications and poor outcomes, including AVN of the femoral head, non-union, coxa vara, and premature physeal closure. AVN of the femoral head is the most common and significant complication, with a reported prevalence of up to 30% in the literature. This complication is particularly troublesome and challenging to manage. Several factors potentially influence the development of complications, such as the timing of fixation, the type and proximity of the fracture, the degree of displacement, the method of reduction, and the quality of reduction. There is significant debate in the literature about the optimal timing of reduction and the risk of femoral head AVN. Some studies suggest that early reduction and fixation within 24 hours can reduce the rate of femoral head AVN. A systematic review found that delaying definitive treatment beyond 24 hours increased the risk of AVN by 4.2 times in patients younger than 19 years. The rationale is that early reduction helps to restore blood flow to the femoral head by 'unkinking' the vessels affected by the injury. However, recent studies have reported conflicting results regarding the rate of femoral head AVN, and no meta-analysis has specifically focused on children prior to physeal closure. Additionally, many studies included patients with Delbet type IV fractures, which have a lower rate of AVN development compared to types I, II, and III. This review aims to evaluate the timing of fixation for femoral neck fractures in children, comparing early versus late fixation while also considering fixation types, displacement types, and fracture locations. The primary outcome is AVN of the femoral head, with secondary outcomes including non-union of the femoral neck, premature physeal fusion, and coxa vara.
dc.identifier.uri	https://opendata.usm.my/handle/123456789/74706
dc.language.iso	en
dc.relation.issupplementedto	https://doi.org/10.1371/journal.pone.0302237
dc.relation.title	Translation and trans-cultural adaptation to the Malay version of the COVID-19 vaccine hesitancy questionnaire among healthcare workers in Malaysia
dc.rights.uri	http://creativecommons.org/licenses/by/4.0/
dc.subject	femoral neck fracture
dc.subject	avascular necrosis
dc.subject	paediatric
dc.subject	fracture neck femur
dc.title	Early Versus Late Fixation of Paediatric Femoral Neck Fractures: A systematic review and meta-analysis
dc.type	Other