Pediatric Femoral Neck Fractures: Unrecognized Association With Autism Spectrum and Neurodevelopmental Disorders

BACKGROUND: This study aimed to identify all pediatric femoral neck fractures and determine the prevalence of autism spectrum disorder (ASD) and other neurodevelopmental disorders (NDD) among these patients. In addition, it aimed to assess their impact on clinical and radiographic outcomes. METHODS: A total of 289 pediatric patients with proximal femoral fractures were initially identified, of whom 140 met the inclusion criteria for femoral neck fractures after excluding pathologic fractures, polytrauma, and incomplete records. Demographic, clinical, and radiographic data, including the presence of ASD and other NDD conditions, were collected. Intraoperative and postoperative complications were recorded. Statistical analyses were performed using (IBM SPSS Statistics; IBM Corp., Armonk, NY) with associations between variables assessed using t tests and χ2 tests, and significance set at P<0.05. RESULTS: Among 140 pediatric patients with femoral neck fractures, 39 (28%) were diagnosed with ASD or NDD. Compared with non-ASD patients, those with ASD exhibited more frequent additional neurological and gastrointestinal/endocrinologic comorbidities, higher prevalence of low preoperative vitamin D levels, and a greater incidence of home-related injuries (all P<0.05). Intraoperative and postoperative complications, including infection and avascular necrosis, were infrequent and did not differ significantly between groups. The mean time for return to daily activities was similar between ASD and non-ASD patients. CONCLUSION: A significant association was observed between pediatric femoral neck fractures and ASD or other NDD, including intellectual disabilities. Children with ASD or NDD demonstrated higher rates of medical comorbidities, low preoperative vitamin D levels, and home‑related injuries, suggesting unique risk profiles in this population. LEVEL OF EVIDENCE: Level III.