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Incidence of osteonecrosis not reduced by earlier time to reduction in pediatric hip fractures
Recently published data indicated children ages 11 years and older were more likely to develop osteonecrosis than children younger than 11 years of age; however, researchers did not find the incidence of osteonecrosis was reduced by earlier time to reduction.
Among 43 patients with 44 hip fractures identified through a search of medical records, the researchers compared findings from patients who developed osteonecrosis (ON) with patients who did not. Data on age, gender, mechanism, time and date of injury, side, fracture type and whether it was displaced, time and date of surgery, reduction type, fixation used, reduction quality, whether surgeons performed decompression and any complication observed such as ON, discrepancies in leg length and coxa vara were collected.
The researchers analyzed radiographs and clinical notes at time of injury, confirming fracture diagnosis. Additionally, the researchers used Fisher exact tests to analyze factors including age, Delbet type, displacement, time to reduction, reduction type (open vs. close), reduction quality and whether or not decompression was performed between the two patient cohorts. Average follow-up was 6.4 years.
Results showed nine of the 44 hip fractures studied developed ON. According to the researchers, surgical age, Delbet classification, time to reduction and type of reduction were the factors most associated with development of ON in children after hip fractures. Development of ON in open reduction cases compared with closed reduction cases was 57% and 18%, respectively, according to the researchers.
Age of 11 years or less was found to be the only statistically significant independent predictor for ON, the researchers reported. ‒ by Monica Jaramillo
Disclosures: Riley reports receiving support by a grant from Akron Children’s Hospital Foundation. Please see the full study for a list of all other authors’ financial disclosures.