The incidence and risk factors for femoral head necrosis after femoral neck fracture in pediatric patients: a systematic review and meta-analysis

Journal of Orthopaedic Surgery and Research

Research Article

Lianbo Xiao¹  Shaoqiang Pei²  Pengfei Xin²  Qi Shi³  Ziqi Li⁴ 

[1] Arthritis Research Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China;Department of Orthopedics, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, 20000, Shanghai, China;Shanghai University of Traditional Chinese Medicine, Shanghai, China;Shanghai University of Traditional Chinese Medicine, Shanghai, China;Arthritis Research Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China;The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China;

关键词: Femoral head necrosis;    Femoral neck fracture;    Pediatric;    Incidence;    Risk factors;    Meta-analysis;   

DOI  :  10.1186/s13018-023-03502-4

 received in 2022-10-26, accepted in 2023-01-02,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe incidence of avascular necrosis (AVN) after pediatric femoral neck fracture (PFNF) in the literature varies widely, and the risk factors associated with AVN after PFNF are controversial. Therefore, this study aimed to accurately investigate the incidence of AVN after PFNF and systematically evaluate and meta-classify their risk factors.MethodsA comprehensive search was performed of PubMed, Web of Science, and Embase. The pooled rate and 95% confidence interval (CI) were used to assess the incidence of AVN after PFNF, and pooled odds ratio (OR) were calculated to measure the effect sizes. In addition, we performed subgroup, stratified, and publication bias analyses.ResultsA total of 30 articles were included in our meta-analysis, with 303 AVN cases among 1185 patients. The pooled incidence of AVN after PFNF was 22% (95% CI 18%, 27%). Subgroup analyses indicated Delbet type I–IV fracture incidences with AVN of 45%, 32%, 17%, and 12%, respectively. The incidence of AVN after PFNF in Asia was 19%, lower than in Africa at 36%, Europe at 26%, and North America at 23%. In addition, the larger sample size group and the earlier published literature group showed a higher incidence of necrosis. Stratified analyses showed that patient age and Delbet fracture classification were both important factors affecting AVN after PFNF (OR = 1.61, p = 0.02 and OR = 3.02, p < 0.001, respectively), while the time to treatment was not (OR = 0.9, p = 0.71).ConclusionThe pooled incidence of AVN after PFNF was ~ 22%; furthermore, the available evidence demonstrates that patient age and Delbet type of fracture were important influencing factors of AVN after PFNF.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 1

12888_2022_4506_Article_IEq2.gif

12888_2022_4506_Article_IEq1.gif

41116_2022_35_Article_IEq68.gif

41116_2022_35_Article_IEq66.gif

Fig. 4

41116_2022_35_Article_IEq63.gif

41116_2022_35_Article_IEq61.gif