The natural history of traumatic femur head necrosis after femoral neck fracture in children and adolescent: a retrospective case series of 64 patients [post]

2020 unpublished
KEYWORDS traumatic femur head necrosis, femoral neck fracture, natural history, children, adolescent, case series study 2 Abstract Background: The natural history of traumatic femur head necrosis (TFHN) after femoral neck fracture (FNF) in children and adolescent is relatively unknown and has never been specifically characterized. As we speculated, the natural history in such population would be poor and characterized as the high risk of femoral head collapse, hip deformity and degeneration in
more » ... nd degeneration in a short term. Methods : This retrospective case series enrolled 64 children and adolescent with TFHN who treated with observational treatment from 2000.1 to 2018.1. The primary outcomes, such as the progression of femoral head collapse, hip deformity (Stulberg classification) and hip degeneration (Tönnis grade), and their prognostic factors were analysed. Results: 42 males and 22 females with a mean age of 13 years (6-16 years), were included. A total of 28 hips (44%) showed unsatisfactory outcome and Twenty-five (39%) hips collapsed progressively during a mean follow-up of 48 months (24-203 months). Finally, 38 hips (59%) experienced hip deformity, 20 of them were class IV/V. 34 hips (53%) generally progressed to osteoarthritis, 14 of them were classified as grades II/III. The location of the lesion and the presence of lateral subluxation were found to be independently related to progression of femoral head collapse; however, the presence of lateral subluxation was the only independent risk factor of severe hip deformity and degeneration. Conclusion: TFHN in children and adolescent is a rapidly progressing disease with a poor natural history characterized by a high risk of femoral head collapse progression. If the lateral subluxation emerged, collapsed cases showed increasingly tendency towards severe hip deformity and degeneration. Background Traumatic femur head necrosis (TFHN) is a debilitating, potentially disabling complication that occurs after femoral neck fracture (FNF) in children and adolescent [1, 2] . As TFHN is the most common complication, a meta-analysis that included 30 studies and 935 immature cases revealed an average incidence of 23.5% [3] . Moreover, to the best of our knowledge, a retrospective study that included 239 hips, as the largest known sample size for paediatric FNF, indicated an incidence of 24.5% for
doi:10.21203/rs.3.rs-17536/v1 fatcat:5x425o5gfzgxff47ucnxavt2py