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Avascular necrosis after femoral neck fracture in children and adolescents: poor prognosis and risk factors

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Abstract

Introduction

Avascular necrosis (AVN) after femoral neck fracture (FNF) is a rare and severe paediatric condition, but only few studies described its prognosis and risk factors. The present study aimed to evaluate the outcomes and independent factors for poor prognosis of AVN after FNF in children and adolescents.

Method

This retrospective study included children and adolescents with AVN after FNF who received conservative treatment (CT group) or non-vascularized bone grafting (NVBG group) between 2000 and 2018. The primary outcomes were the risk of hip arthritis (Tönnis grade) and hip deformity risk (Stulberg classification). All patients were followed for at least two years to assess AVN progression.

Results

Study included 81 patients. In the CT group, 23/43 patients (53.4%) developed hip arthritis, and 24/43 patients (55.8%) showed hip deformity. In the NVBG group, 23/38 patients (60.5%) developed hip arthritis, and 34/38 patients (89.5%) had a hip deformity. The multivariable analysis indicated that NVBG surgery had no significant effect on the outcomes. Post-treatment femoral head collapse (P = 0.05, OR = 3.80, 95% CI = 1.01–14.29) and post-treatment hip subluxation (P = 0.01, OR = 2.85, 95% CI = 2.31–129.56) were independent risk factors for severe hip arthritis. Post-treatment femoral head collapse (P < 0.01, OR = 7.64, 95% CI = 3.23–18.04) and pre-treatment hip subluxation (P = 0.02, OR = 7.33, 95% CI = 1.44–37.41) were independent risk factors for severe hip deformity.

Conclusion

Neither CT nor NVBG have demonstrated superiority regarding long-term outcomes in patients with AVN after FNF. Upon the disease progression to severe collapse with subluxation and severe arthritis, further hip preservation attempts could be futile.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Acknowledgements

The authors would like to thank all study participants who were enrolled in this study.

Funding

This study was supported by Youth Program of National Natural Science Foundation of China (81904226).

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Author notes

  1. Ziqi Li and Zhikun Zhuang contributed equally to this work

Authors and Affiliations

  1. Department of Joint Diseases, Traumatology & Orthopedics Institute of Guangzhou University of Chinese Medicine, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, Guangdong, China

    Ziqi Li, Zhinan Hong, Leilei Chen, Wei He & Qiushi Wei

  2. Quanzhou Orthopedic-Traumatological Hospital of Fujian Traditional Chinese Medicine University, Quanzhou, 362000, Fujian, China

    Zhikun Zhuang

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  1. Ziqi Li
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Contributions

Ziqi Li and Zhikun Zhuang carried out the studies, participated in collecting data, and drafted the manuscript. Zhinan Hong and Leilei Chen performed the statistical analysis and participated in its design. Wei He and Qiushi Wei participated in acquisition, analysis, or interpretation of data and draft the manuscript. All authors have read and approved the final manuscript.

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Correspondence to Wei He or Qiushi Wei.

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The study was approved by the ethics committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine. The requirement for individual consent was waived by the committee.

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All participants provided written informed consent.

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The authors declare no competing interests.

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Li, Z., Zhuang, Z., Hong, Z. et al. Avascular necrosis after femoral neck fracture in children and adolescents: poor prognosis and risk factors. International Orthopaedics (SICOT) 45, 2899–2907 (2021). https://doi.org/10.1007/s00264-021-05210-2

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