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Background <p>Avascular necrosis (AVN) is a severe complication following pediatric femoral neck fractures (PFNFs). Identifying risk factors for AVN is critical for guiding timely treatment and follow-up. However, prior studies report inconsistent associations. This systematic review and meta-analysis aimed to identify risk factors associated with AVN after PFNFs.</p> Methods <p>A comprehensive literature search was conducted in PubMed, Web of Science, EMBASE, and the Cochrane Library through April 30, 2025. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated to assess the association between potential risk factors and AVN. Leave-one-out sensitivity analyses, meta-regression, and subgroup analyses were performed.</p> Results <p>Thirty-four studies comprising 1332 pediatric patients (1340 fractures) were included. Older age (≥ 12&#xa0;years; RR = 1.40, 95% CI 1.09–1.82), Delbet type I/II fractures (RR = 1.96, 95% CI 1.60–2.39), initial displacement (RR = 2.98, 95% CI 2.04–4.35), and poor reduction quality (RR = 2.43, 95% CI 1.46–4.05) were significantly associated with increased AVN risk. Gender, injury mechanism, time to reduction, and reduction method showed no overall association. Meta-regression identified follow-up duration as a significant moderator. Subgroup analyses of long-term follow-up (≥ 5&#xa0;years) revealed that delayed reduction increased AVN risk (RR = 2.63, 95% CI 1.35–5.11), while closed reduction and internal fixation (CRIF) reduced risk compared to open reduction (RR = 0.40, 95% CI 0.24–0.65). Subgroup differences between long-term and short-term follow-up were both statistical significant.</p> Conclusions <p>Older age, Delbet type I/II classification, initial displacement, and poor reduction quality are significant predictors of AVN following PFNFs. Early reduction and CRIF may provide superior long-term outcomes. Further high-quality prospective studies with extended follow-up are needed to confirm these findings.</p>

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Risk factors for avascular necrosis in pediatric femoral neck fractures: a systematic review and meta-analysis

  • 期刊论文

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  • 发表日期：

    2025年11月11日

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  • Bin Dong,
  • Feihu Li,
  • Chenjing Li

摘要

Background

Avascular necrosis (AVN) is a severe complication following pediatric femoral neck fractures (PFNFs). Identifying risk factors for AVN is critical for guiding timely treatment and follow-up. However, prior studies report inconsistent associations. This systematic review and meta-analysis aimed to identify risk factors associated with AVN after PFNFs.

Methods

A comprehensive literature search was conducted in PubMed, Web of Science, EMBASE, and the Cochrane Library through April 30, 2025. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated to assess the association between potential risk factors and AVN. Leave-one-out sensitivity analyses, meta-regression, and subgroup analyses were performed.

Results

Thirty-four studies comprising 1332 pediatric patients (1340 fractures) were included. Older age (≥ 12 years; RR = 1.40, 95% CI 1.09–1.82), Delbet type I/II fractures (RR = 1.96, 95% CI 1.60–2.39), initial displacement (RR = 2.98, 95% CI 2.04–4.35), and poor reduction quality (RR = 2.43, 95% CI 1.46–4.05) were significantly associated with increased AVN risk. Gender, injury mechanism, time to reduction, and reduction method showed no overall association. Meta-regression identified follow-up duration as a significant moderator. Subgroup analyses of long-term follow-up (≥ 5 years) revealed that delayed reduction increased AVN risk (RR = 2.63, 95% CI 1.35–5.11), while closed reduction and internal fixation (CRIF) reduced risk compared to open reduction (RR = 0.40, 95% CI 0.24–0.65). Subgroup differences between long-term and short-term follow-up were both statistical significant.

Conclusions

Older age, Delbet type I/II classification, initial displacement, and poor reduction quality are significant predictors of AVN following PFNFs. Early reduction and CRIF may provide superior long-term outcomes. Further high-quality prospective studies with extended follow-up are needed to confirm these findings.