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Orthopedic Robot-Assisted Femoral Neck System in the Treatment of Femoral Neck Fracture
Published on: March 3, 2023
Risk factors for avascular necrosis in pediatric femoral neck fractures: a systematic review and meta-analysis
Bin Dong1, Feihu Li2, Chenjing Li2
1Department of Pediatric Orthopedics, Yuncheng Central Hospital affiliated to Shanxi Medical University, No. 3690, Hedong East Street, Yanhu District, Yuncheng, 044000, Shanxi Province, China. cuel84@163.com.
Insights
Older age, fracture type, initial displacement, and poor reduction quality increase avascular necrosis (AVN) risk in pediatric femoral neck fractures (PFNFs). Early reduction and closed reduction with internal fixation (CRIF) may improve outcomes.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Trauma surgery
Background:
- Avascular necrosis (AVN) is a severe complication of pediatric femoral neck fractures (PFNFs).
- Identifying risk factors for AVN is crucial for effective management and follow-up.
- Previous studies have yielded inconsistent findings regarding AVN risk factors.
Purpose of the Study:
- To systematically review and meta-analyze existing literature.
- To identify significant risk factors associated with AVN after PFNFs.
- To provide evidence-based guidance for clinical practice.
Main Methods:
- Comprehensive literature search across major databases (PubMed, Web of Science, EMBASE, Cochrane Library) up to April 2025.
- Calculation of risk ratios (RRs) and 95% confidence intervals (CIs) for risk factor associations.
- Performance of sensitivity, meta-regression, and subgroup analyses to explore heterogeneity.
Main Results:
- Thirty-four studies involving 1332 pediatric patients were analyzed.
- Older age (≥12 years), Delbet type I/II fractures, initial displacement, and poor reduction quality significantly increased AVN risk.
- Long-term follow-up revealed delayed reduction increased AVN risk, while closed reduction and internal fixation (CRIF) decreased it.
Conclusions:
- Older age, Delbet type I/II, initial displacement, and poor reduction quality are key predictors of AVN post-PFNF.
- Timely reduction and CRIF may lead to better long-term outcomes.
- High-quality prospective studies with extended follow-up are warranted.
Background:
Avascular necrosis (AVN) is a severe complication following pediatric femoral neck fractures (PFNFs). Identifying risk factors for AVN is critical for guiding timely treatment and follow-up. However, prior studies report inconsistent associations. This systematic review and meta-analysis aimed to identify risk factors associated with AVN after PFNFs.
Methods:
A comprehensive literature search was conducted in PubMed, Web of Science, EMBASE, and the Cochrane Library through April 30, 2025. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated to assess the association between potential risk factors and AVN. Leave-one-out sensitivity analyses, meta-regression, and subgroup analyses were performed.
Results:
Thirty-four studies comprising 1332 pediatric patients (1340 fractures) were included. Older age (≥ 12 years; RR = 1.40, 95% CI 1.09-1.82), Delbet type I/II fractures (RR = 1.96, 95% CI 1.60-2.39), initial displacement (RR = 2.98, 95% CI 2.04-4.35), and poor reduction quality (RR = 2.43, 95% CI 1.46-4.05) were significantly associated with increased AVN risk. Gender, injury mechanism, time to reduction, and reduction method showed no overall association. Meta-regression identified follow-up duration as a significant moderator. Subgroup analyses of long-term follow-up (≥ 5 years) revealed that delayed reduction increased AVN risk (RR = 2.63, 95% CI 1.35-5.11), while closed reduction and internal fixation (CRIF) reduced risk compared to open reduction (RR = 0.40, 95% CI 0.24-0.65). Subgroup differences between long-term and short-term follow-up were both statistical significant.
Conclusions:
Older age, Delbet type I/II classification, initial displacement, and poor reduction quality are significant predictors of AVN following PFNFs. Early reduction and CRIF may provide superior long-term outcomes. Further high-quality prospective studies with extended follow-up are needed to confirm these findings.
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