From paediatric trauma to adult outcomes: surgical management and long-term results in paediatric femoral neck fractures

The current study aimed to examine the short- and long-term relationship between complications and radiologic and functional outcomes in surgically treated patients with Delbet type II and type III paediatric femoral neck fractures (PFNFs). We examined the medical records of PFNFs from 2006 to 2013. Retrospective analysis examined patient demographics, fracture types, surgical procedures, complications, and follow-up outcomes. We used Ratliff’s method for early radiological and clinical assessment of patients in the second postoperative year. At the final follow-up, Tönnis criteria and the Harris hip score were used to evaluate late findings in adulthood. Over an average follow-up of 157.2 months, we evaluated 26 patients, with an average age of 10.7 years. Early complications included coxa breva (34.6%) and limb length discrepancy (LLD) (30.8%); late complications included osteoarthritis (OA) (23.1%) and LLD (23.1%). During the early follow-up period, avascular necrosis (AVN) was observed in 6 individuals, accounting for 23.1% of the cases. There were no cases of nonunion or infection detected in any of the patients. AVN correlated with non-anatomic reduction, poor Ratliff classification (early), lower Harris hip scores (late), and OA (late) (p < 0.05). Non-anatomic reduction was significantly correlated with all three main complications (p < 0.05). Anatomical reduction significantly influences early and late complications following PFNF surgery. Therefore, we strongly affirm that prioritising anatomical reduction is more important than any other criterion mentioned in the literature. The AVN predicts OA and poor long-term outcomes. Coxa breva and LLD did not correlate with poor clinical outcomes or the onset of OA.