Open reduction versus closed reduction in internal fixation of displaced femoral neck fracture in children: a systematic review and meta-analysis

Journal of Orthopaedic Surgery and Research

Systematic Review

Chul-Ho Kim¹  Eic Ju Lim²  Hyun-Chul Shon²  Minboo Kim²  Boo-Seop Kim³ 

[1] Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, Republic of Korea;Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea;Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea;Department of Orthopaedic Surgery, Hyundae General Hospital, Chung-Ang University College of Medicine, Namyangju-Si, Kyunggi-Do, Republic of Korea;

关键词: Open reduction;    Closed reduction;    Children;    Pediatric;    Femoral neck fracture;   

DOI  :  10.1186/s13018-023-03525-x

 received in 2022-06-30, accepted in 2023-01-10,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe quality of reduction is an important factor affecting clinical outcomes for displaced femoral neck fractures (FNFs). However, concerns remain about the invasiveness of open reduction and internal fixation (ORIF) as compared to that of closed reduction and internal fixation (CRIF), and the choice between ORIF and CRIF as an optimal treatment strategy for displaced pediatric FNF remains controversial.Materials and MethodsMEDLINE, Embase, and the Cochrane Library were systematically searched for studies published up to December 22, 2022, that compared ORIF and CRIF techniques for treating FNF in children. Pooled analysis identified differences in surgical outcomes between ORIF and CRIF, especially regarding postoperative complications, such as osteonecrosis of the femoral head (ONFH), nonunion, coxa vara deformity, leg-length discrepancy LLD, and premature physeal closure (PPC).ResultsWe included 15 studies with 635 pediatric FNF cases in our review. Of these, 324 and 311 were treated with ORIF and CRIF, respectively. The pooled analysis revealed that no significant differences existed between each reduction technique for ONFH (odds ratio [OR] = 0.89; 95% confidence interval [CI] 0.51–1.56; P = 0.69), nonunion (OR = 0.51; 95% CI 0.18–1.47; P = 0.21), coxa vara deformity (OR = 0.58; 95% CI 0.20–1.72; P = 0.33), LLD (OR = 0.57; 95% CI 0.18–1.82; P = 0.35), and PPC (OR = 0.72; 95% CI 0.11–4.92; P = 0.74).ConclusionsDespite concerns about the invasiveness of ORIF, no differences in complications exist between ORIF and CRIF after FNF in children. Therefore, we believe that ORIF should be performed in FNF when the fracture is irreducible by closed manner.

【 授权许可】

CC BY   
© The Author(s) 2023

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