Outcomes of Pediatric Femoral Neck Fractures: Impact of Reduction Quality and Age

Aim: Pediatric femoral neck fractures are extremely rare but carry a high risk of complications such as avascular necrosis (AVN), nonunion, and coxa vara. This study aimed to evaluate clinical and radiological outcomes and to identify prognostic factors associated with adverse events. Materials and Methods: A retrospective cohort of 87 patients (aged 1–16 years) with femoral neck fractures treated at a tertiary trauma center between January 2017 and July 2022 was analyzed. Demographic, clinical, radiological, and operative data were reviewed. Surgical delay was categorized as ≤24 hours or >24 hours, and reduction quality was graded. Outcomes included union time, AVN, nonunion, coxa vara, and revision surgery. Group comparisons were made using appropriate parametric or non-parametric tests for continuous variables and Chi-square or Fisher’s exact tests for categorical variables. Results: The mean age was 9.5 years, and 66.7% of patients were male. Most fractures were Delbet type II or III. Definitive fixation within 24 hours was achieved in 82.8% of cases. The overall complication rate was 17.2%, including nonunion (6.9%), coxa vara (3.4%), and AVN (3.4%). Surgical delay beyond 24 hours was significantly associated with nonunion (p = 0.03), while poor reduction quality correlated with coxa vara (p = 0.04). Two patients (2.3%) required revision surgery due to implant failure. Conclusion: Surgical delay and poor reduction quality were the strongest predictors of adverse outcomes. Early fixation within 24 hours and meticulous anatomical reduction are essential to minimize complications in this rare but high-stakes pediatric injury.