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Is there an alternative to the Delbet-Colonna classification? Introduction and reliability assessment of a new classification system for paediatric femoral neck fractures: preliminary results

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Abstract

Purpose

The purpose of this study was to introduce a new classification system for paediatric femoral neck fractures (PFNFs) and to evaluate its reliability.

Methods

Two hundred and eight unilateral PFNFs (mean patient age: 9.0 ± 4.8 years) were included. Based on preoperative radiographs, the new classification system distinguished PFNFs without anterior or posterior translation (Type I), PFNFs with anterior (Type II) or posterior (Type III) translation, PFNFs with a comminuted medial or posterior column (Type IV), and subtrochanteric femoral fractures (SFFs; Type V). Radiographs were evaluated twice with an interval of two weeks by 19 raters with different specialties, experiences and geographical origins. The results were compared with a selection of 50 patient age-matched unilateral PFNFs and SFFs (mean patient age: 9.1 ± 4.9 years). These were graded twice by the same graders according to the Delbet-Colonna (D-C) classification.

Results

Four radiologists and 15 paediatric orthopaedic surgeons from Europe and Asia graded the radiographs. Fair agreement was found between radiologists (κ = 0.296 ± 0.01) and surgeons (κ = 0.3 ± 0.005) (P = 0.17), although more experienced surgeons performed better than less experienced ones; a similar fair assessment was found for raters from Europe (κ = 0.309 ± 0.021) and Asia (κ = 0.3 ± 0.006) and for type II, III and IV fractures; the κ value in the first evaluation (0.309) was similar to that in the second evaluation (0.298).

The overall κ value of the D-C classification subtypes was significantly higher (0.599 ± 0.217) than that of the new classification, 0.326 ± 0.162 (t = 3.190 P = 0.005).

Conclusions

The new classification system showed fair reliability relative to the D-C classification. The reliability of the new classification system was not affected by the specialty or geographic origin of the rater or the evaluation round, only by rater experience level. The concordance was worse for PFNFs with anterior or posterior translation or with a comminuted medial or posterior columns.

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References

  1. Davison BL, Weinstein SL (1992) Hip fractures in children: a long-term follow-up study. J Pediatr Orthop 12:355–358. https://doi.org/10.1097/01241398-199205000-00014

    Article  CAS  PubMed  Google Scholar 

  2. Mirdad T (2002) Fractures of the neck of femur in children: an experience at the Aseer Central Hospital, Abha, Saudi Arabia. Injury 33:823–827. https://doi.org/10.1016/s0020-1383(02)00013-x

    Article  PubMed  Google Scholar 

  3. Bimmel R, Bakker A, Bosma B, Michielsen J (2010) Paediatric hip fractures: a systematic review of incidence, treatment options and complications. Acta Orthop Belg 76:7–13

    PubMed  Google Scholar 

  4. Colonna PC (1929) Fracture of the neck of the femur in children. Am J Surg 6:793

    Article  Google Scholar 

  5. Schroeder JD, Turner SP, Buck E (2022) Hip fractures: diagnosis and management. Am Fam Physician 106:675–683

    PubMed  Google Scholar 

  6. Riley PM Jr, Morscher MA, Gothard MD, Riley PM Sr (2015) Earlier time to reduction did not reduce rates of femoral head osteonecrosis in pediatric hip fractures. J Orthop Trauma 29:231–238. https://doi.org/10.1097/BOT.0000000000000226

    Article  PubMed  Google Scholar 

  7. Varshney MK, Kumar A, Khan SA, Rastogi S (2009) Functional and radiological outcome after delayed fixation of femoral neck fractures in pediatric patients. J Orthop Traumatol 10:211–216. https://doi.org/10.1007/s10195-009-0072

    Article  PubMed  PubMed Central  Google Scholar 

  8. Wang W, Xiong Z, Li Y, Guo Y, Li M, Mei H, Canavese F, Chen S, Chinese Multicenter Pediatric Orthopedic Study Group (CMPOS) (2022) Variables influencing radiological fracture healing in children with femoral neck fractures treated surgically: a review of 177 cases. Orthop Traumatol Surg Res 108:103052. https://doi.org/10.1016/j.otsr.2021.103052

    Article  PubMed  Google Scholar 

  9. Wang W, Xiong Z, Zhao C, He B, Mei H, Li Y, Canavese F, Pan Y, Chen S (2022) Do the number, size, and position of partially threaded screws affect the radiological healing of surgically treated displaced femoral neck fractures? A review of 136 children. Medicina (Kaunas) 58:1153. https://doi.org/10.3390/medicina58091153

    Article  PubMed  Google Scholar 

  10. Zlotorowicz M, Czubak J, Caban A, Kozinski P, Boguslawska-Walecka R (2013) The blood supply to the femoral head after posterior fracture/dislocation of the hip, assessed by CT angiography. Bone Joint J 95-B:1453–1457. https://doi.org/10.1302/0301-620X.95B11.32383

    Article  CAS  PubMed  Google Scholar 

  11. Zlotorowicz M, Szczodry M, Czubak J, Ciszek B (2011) Anatomy of the medial femoral circumflex artery with respect to the vascularity of the femoral head. J Bone Joint Surg (Br) 93:1471–1474. https://doi.org/10.1302/0301-620X.93B11.26993

    Article  CAS  PubMed  Google Scholar 

  12. Lavigne M, Kalhor M, Beck M, Ganz R, Leunig M (2005) Distribution of vascular foramina around the femoral head and neck junction: relevance for conservative intracapsular procedures of the hip. Orthop Clin North Am 36:171–176. https://doi.org/10.1016/j.ocl.2005.02.002

    Article  PubMed  Google Scholar 

  13. Wang W, Li Y, Guo Y, Li M, Mei H, Shao J, Xiong Z, Li J, Canavese F, Chen S, Chinese Multicenter Pediatric Orthopedic Study Group (CMPOS) (2020) 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. Int Orthop 44(129):139. https://doi.org/10.1007/s00264-019-04429-4

    Article  Google Scholar 

  14. Ripamonti C, Lisi L, Avella M (2014) Femoral neck shaft angle width is associated with hip-fracture risk in males but not independently of femoral neck bone density. Br J Radiol 87:20130358. https://doi.org/10.1259/bjr.20130358

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Machado MM, Fernandes PR, Zymbal V, Baptista F (2014) Human proximal femur bone adaptation to variations in hip geometry. Bone 67:193–199. https://doi.org/10.1016/j.bone.2014.07.001

    Article  CAS  PubMed  Google Scholar 

  16. Pan Y, Lu X, Lin R, Zhang X, Mei H, Guo Y, Chen S (2020) Free fracture fragment predicts poorer outcomes in adolescents with delbet II femoral neck fracture. J Surg Res 248:14–19. https://doi.org/10.1016/j.jss.2019.10.016

    Article  PubMed  Google Scholar 

  17. Pombo MW, Shilt JS (2006) The definition and treatment of pediatric subtrochanteric femur fractures with titanium elastic nails. J Pediatr Orthop 26:364–370. https://doi.org/10.1097/01.bpo.0000203005.50906.41

    Article  PubMed  Google Scholar 

  18. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  19. Wang WT, Li YQ, Guo YM, Li M, Mei HB, Shao JF, Xiong Z, Li J, Canavese F, Chen SY (2019) Risk factors for the development of avascular necrosis after femoral neck fractures in children: a review of 239 cases. Bone Joint J 101-B:1160–1167. https://doi.org/10.1302/0301-620X.101B9.BJJ-2019-0275.R1

    Article  PubMed  Google Scholar 

  20. Wang W, Li Y, Xiong Z, Guo Y, Li M, Mei H, Shao J, Li J, Canavese F, Chen S (2022) Effect of the number, size, and location of cannulated screws on the incidence of avascular necrosis of the femoral head in pediatric femoral neck fractures: a review of 153 cases. J Pediatr Orthop 42:149–157. https://doi.org/10.1097/BPO.0000000000002018

    Article  PubMed  Google Scholar 

  21. Beutel BG, Girdler SJ, Collins JA, Otsuka NY, Chu A (2018) Characterization of proximal femoral anatomy in the skeletally-immature patient. J Child Orthop 12:167–172. https://doi.org/10.1302/1863-2548.12.180011

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors wish to acknowledge and thank the following individuals for participating in this study: Flavia Alberghina MD (Ireland), Antonio Andreacchio MD (Italy), Marco Corradin MD (Italy), Fabrizio Di Maria MD (Italy), Blandine Hamet MD (France), Giovanni Lucchesi MD (Italy), Nicolas Mainard MD (France), Laurence Mainard-Simard MD (France), Marco Sapienza MD (Italy), Gianluca Testa MD (Italy), Vito Pavone MD (Italy), Ran Lin MD (China), Riccardo Sacco MD (Italy), ShengPing Tang MD (China), Andrea Vescio MD (Italy), Hui Li MD (China) and ZhiBin Wu MD (China).

Funding

This study is supported by Sanming Project of Medicine in Shenzhen (SZSM 202011012) and Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma (2020Y2014).

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Author notes

  1. WenTao Wang, DianHua Huang, Zhu Xiong, YueMing Guo and PengRan Liu contributed equally to the writing of this article.

Authors and Affiliations

  1. Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, 518107, Guangdong Province, China

    WenTao Wang

  2. Department of Pediatric Orthopedics, Fuzhou Second Hospital, Fuzhou, 350007, Fujian Province, China

    DianHua Huang & ShunYou Chen

  3. Department of Pediatric Orthopedics, Shenzhen Children’s Hospital, Shenzhen, 518034, Guangdong Province, China

    Zhu Xiong

  4. Department of Pediatric Orthopaedics, Foshan Hospital of Traditional Chinese Medicine, Foshan, 528099, Guangdong Province, China

    YueMing Guo

  5. Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China

    PengRan Liu

  6. Department of Pediatric Orthopaedics, Children’s Hospital of Chongqing Medical University, Chongqing, 400015, China

    Ming Li

  7. Department of Pediatric Orthopaedics, Hunan Children’s Hospital, Changsha, 410007, Hunan Province, China

    HaiBo Mei

  8. Department of Pediatric Orthopaedics, Guangzhou Women and Children’s Medical Center, GuangZhou Medical University, Guangzhou, 510623, Guangdong Province, China

    YiQiang Li

  9. Department of Pediatric Orthopaedics, Lille University Center, Jeanne de Flandre Hospital, Avenue Eugène Avinée, 59037, Lille Cedex, France

    Federico Canavese

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  1. WenTao Wang
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  9. Federico Canavese
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Correspondence to ShunYou Chen.

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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.

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Wang, W., Huang, D., Xiong, Z. et al. Is there an alternative to the Delbet-Colonna classification? Introduction and reliability assessment of a new classification system for paediatric femoral neck fractures: preliminary results. International Orthopaedics (SICOT) (2023). https://doi.org/10.1007/s00264-023-06051-x

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