Plate Versus Screw Fixation in Treating Pediatric Femoral Neck Fractures: A Systematic Review

Area of Science:

• Orthopedic surgery
• Pediatric orthopedics
• Traumatology

Background:

• Limited direct comparisons exist between plate and screw fixation for pediatric femoral neck fractures.
• This systematic review addresses this gap by comparing postoperative outcomes of these two fixation methods.

Purpose of the Study:

• To systematically compare the postoperative outcomes of plate fixation versus screw fixation in treating pediatric femoral neck fractures.
• To evaluate functional assessments and identify postoperative complications associated with each fixation method.

Main Methods:

• A systematic review of studies from PubMed, EMBASE, Cochrane Library, and Google Scholar.
• Inclusion of 31 studies with 950 pediatric femoral neck fracture cases.
• Evaluation of surgical outcomes including functional assessments (Ratliff criteria) and complications.

Main Results:

• Functional outcomes were comparable between plate and screw fixation groups.
• Plate fixation demonstrated lower rates of avascular necrosis and premature physeal closure.
• Slightly higher coxa vara incidence with plate fixation; similar nonunion and leg length discrepancy rates.
• Subgroup analysis showed plate fixation reduced avascular necrosis and leg length discrepancy risks in Delbet III/IV and displaced fractures.

Conclusions:

• Plate fixation appears superior for pediatric femoral neck fractures.
• Reduced risks of avascular necrosis and premature physeal closure favor plate fixation.
• Plate fixation is particularly advantageous for Delbet type III/IV or displaced fractures.