Principles or Resources? Best Management of Pediatric Femoral Neck Fractures.

Authors

Caroline L Kim, Sulagna Sarkar, Alberto Daniel Navarro Vergara, Alexandre Arkader

Published in

Journal of pediatric orthopedics. Oct 19, 2026. Epub Oct 19, 2026.

Abstract

Pediatric femoral neck fractures (PFNF) are rare but have a reported complication rate of >30%. To date, there remains a lack of consensus on the definitive risk factors for AVN following PFNF. By comparing the outcomes of PFNF treated at a major US metropolitan area tertiary-level 1 pediatric trauma center (group 1) to an equivalent trauma hospital in a major Latin American capital (group 2), we sought to weigh whether treatment principles or resources are more important for a favorable result.
This was a retrospective review of all children (<18 years old) treated for PFNF in the past 10 years at each location. Demographics, treatment, and outcome variables were collected. Fractures were classified by Delbet criteria. Patients with incomplete fractures, pathologic fractures, and those with short follow-up (<3 months) were excluded. Univariate and bivariate statistics were applied.
In all, 74 fractures (73 children) were included, 39 from group 1 and 35 from group 2 (52% male, mean age 11.0±4.11). Patients from group 1 (12.5±3.95 years old) were significantly older compared with group 2 (9.35±3.72 years old, P<0.001). Group 2 had a significantly higher proportion of type 4 Delbet fractures (37% vs. 8%, P=0.01) while no other differences in fracture characteristics were observed between groups. Of the patients who underwent operative treatment for their fractures, the time to surgery was significantly shorter in group 1 (4.42 days) compared with group 2 (7.56 days, P<0.001). The preferred method of surgery was open reduction and internal fixation (ORIF) at group 1 and closed reduction and percutaneous pinning at group 2 (P=0.05). There were no differences in overall complication rates, including AVN (P>0.05).
While these 2 institutions differ in resources, such as the ability to perform surgery urgently or hardware availability, and despite differences in fracture type, there were no significant differences in the outcome and incidence of complications, including AVN.
Level 3, Retrospective comparative study.

PMID:
42895813
Bibliographic data and abstract were imported from PubMed on 20 Oct 2026.

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