Sat., 10/6/12 Pediatric Fractures, PAPER #112, 3:46 pm OTA-2012
Do Any Factors Influence the Development of Femoral Head Osteonecrosis in Pediatric Femoral Neck Fractures?
Patrick M. Riley, Jr, MD1; Melanie A. Morscher, BS2; M. David Gothard, MS3;
Patrick M. Riley, MD2;
1Summa Health System, Akron, Ohio, USA;
2Akron Children’s Hospital, Akron, Ohio, USA;
3Biostats, East Canton, Ohio, USA
Purpose: Femoral neck fractures account for less than 1% of all pediatric fractures; however, femoral head osteonecrosis (ON) after this injury has been reported to range from 0% to 92%. The aim of this investigation was to add our experience to the literature and identify factors that may increase the risk of ON in pediatric patients with femoral neck fractures. We hypothesized that age, Delbet fracture classification, and time to reduction will affect the risk of ON in pediatric patients treated for femoral neck fractures.
Methods: An IRB-approved retrospective review identified 255 children with hip fractures treated at our institution from 1983 to 2009. Children were excluded if they had metabolic bone disease, subtrochanteric or pathologic fractures, slipped capital femoral epiphysis, or less than 1-year follow-up. This left 43 patients with 44 fractures in our study. Factors analyzed included age, Delbet fracture classification, time to reduction, displacement, reduction quality and type, and whether or not a decompression was performed. Fisher exact tests were used with P <0.05 considered statistically significant.
Results: Of the 44 cases included in the study, 9 (20%) developed ON. The rate of ON for Delbet type I fractures was 50% (2 of 4), type II was 28% (5 of 18), type III was 8% (1 of 12), and type IV was 10% (1of 10). Age ≥11 years was the only statistically significant independent predictor of ON (P = 0.04). There were no significant differences of ON rates between those undergoing early (≤12 hours) or late reduction or those with or without capsular decompression. Further subanalysis of the age ≥11 years did not identify any other significant predictors; however, the difference in ON rates between those with open and closed reductions did trend towards statistical significance (P = 0.068).
Conclusion: Our study of 44 femoral neck fractures is a relatively large case series with low ON rates (20%). Our data show that ON is more likely to develop in children ≥11 years of age. We were unable to demonstrate that early reduction (≤12 hours) decreased ON rates when compared to reductions that were delayed.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.