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Topic:

​

Issue:

Leg

Category:

Trauma

Title:

Treatment of Delbet II/III Pediatric Femoral Neck Fractures With Proximal Femoral Locking Plate Versus Cannulated Screws

Author:

Haider, Shamrez BS; Harris, Timothy J. MD; Turner, Alexander C. BS, BA; Podeszwa, David A. MD; Hartman, Courtney A. MS; Morris, William Z. MD

Journal:

Journal of Pediatric Orthopaedics

Date:

April 2024

Reference:

44(4):p 213-220, DOI: 10.1097/BPO.0000000000002625

Level Of Evidence:

III

# of Patients:

42

Study Type:

Retrospective cohort study

Location:

A multicenter study

Summary:

The study compared outcomes of pediatric Delbet II/III femoral neck fractures treated with Proximal Femoral Locking Plates (PFLP) versus Cannulated Screws (CS), focusing on rates of union, coxa vara, avascular necrosis (AVN), and femoral alignment.

Methods:

Inclusion: Pediatric patients (<18 years) with Delbet II/III traumatic, nonpathologic femoral neck fractures treated with either PFLP or CS. Exclusion: Pathologic fractures or cases with less than 6 months of radiographic follow-up. Radiographic outcomes (union, AVN, neck-shaft angle, and articulotrochanteric distance (ATD)) and rates of secondary surgery were assessed.

Exclusions:

Patients with pathologic fractures or insufficient follow-up.

Results:

Union Rates: PFLP (81%) vs. CS (88%), P=0.66. AVN Rates: PFLP (25%) vs. CS (35%), P=0.73. ATD: Preserved in the PFLP group (P=0.57) but significantly reduced in the CS group (P=0.001). No significant difference in neck-shaft angle between injured and contralateral hips for either treatment. Secondary surgery was equally required in both groups (62%).

Conclusions:

PFLPs do not significantly increase the risk of nonunion or AVN in Delbet II/III femoral neck fractures compared with CS. PFLPs may provide better preservation of anatomical articulotrochanteric distance, suggesting a potential advantage over screw fixation in maintaining proximal femoral alignment.

Relevance:

Limitations:

Perspective:

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