Pathological progress of traumatic femur head necrosis after femoral neck fracture in children and adolescents: a case series study

The pathological progression and prognosis of traumatic femur head necrosis (TFHN) after femoral neck fracture (FNF) in children and adolescent is relatively unknown and has never been specifically characterized. As we speculated, the prognosis in such population would be poor and characterized as the high risk of femoral head collapse, hip deformity and degeneration in a short term. This retrospective case series enrolled 64 children and adolescent with TFHN who treated with observational treatment from 2000.1 to 2018.1. The primary outcomes, the progression of femoral head collapse, hip deformity (Stulberg classification) and hip degeneration (Tönnis grade), and their prognostic factors were analysed. Sixty-four patients with a mean age of 13 years (6–16 years) were included. A total of 28 hips (44%) showed unsatisfactory outcome and 25 (39%) hips collapsed progressively during a mean follow-up of 48 months (24–203 months). Finally, 38 hips (59%) experienced hip deformity, 20 of them were Class IV/V. Thirty-four hips (53%) generally progressed to osteoarthritis, 14 of them were classified as Grades II/III. The location of the lesion and the presence of subluxation were found to be related to progression of collapse; however, the presence of subluxation was the only independent risk factor of severe hip deformity and degeneration. TFHN in children and adolescent is a rapidly progressing disease with a poor prognosis characterized by a high risk of femoral head collapse progression. If the subluxation emerged, collapsed cases showed increasingly tendency towards hip deformity and degeneration.

Pathological progress and prognosis of traumatic femur head necrosis after femoral neck fracture in children and adolescent: a retrospective case series of 64 patients

Background: The pathological progression and prognosis of traumatic femur head necrosis (TFHN) after femoral neck fracture (FNF) in children and adolescent is relatively unknown and has never been specifically characterized. As we speculated, the prognosis in such population would be poor and characterized as the high risk of femoral head collapse, hip deformity and degeneration in a short term.Methods: This retrospective case series enrolled 64 children and adolescent with TFHN who treated with observational treatment from 2000.1 to 2018.1. The primary outcomes, such as the progression of femoral head collapse, hip deformity (Stulberg classification) and hip degeneration (Tönnis grade), and their prognostic factors were analysed.Results: 42 males and 22 females with a mean age of 13 years (6-16 years), were included. A total of 28 hips (44%) showed unsatisfactory outcome and Twenty-five (39%) hips collapsed progressively during a mean follow-up of 48 months (24-203 months). Finally, 38 hips (59%) experienced hip deformity, 20 of them were class IV/V. 34 hips (53%) generally progressed to osteoarthritis, 14 of them were classified as grades II/III. The location of the lesion and the presence of lateral subluxation were found to be independently related to progression of femoral head collapse; however, the presence of lateral subluxation was the only independent risk factor of severe hip deformity and degeneration.Conclusion: TFHN in children and adolescent is a rapidly progressing disease with a poor prognosis characterized by a high risk of femoral head collapse progression. If the lateral subluxation emerged, collapsed cases showed increasingly tendency towards severe hip deformity and degeneration.

The fate of ARCO stage-II femur head necrosis with ring-shaped hardening zone: forty-one hips followed for average of nine years

Purpose The goal of this retrospective study is to report the lower collapse risk and good prognosis of the ARCO stage-II femur head necrosis with ring-shaped hardening zone. Methods We retrospectively recruited 30 patients (41 hips) with ring-shaped hardening zone from the ARCO stage II femur head necrosis. In these 41 hips with ring-shaped hardened bands, we found two subtypes which named type A and type B by us respectively. These hips were followed for a minimum of 5 years after the diagnosis. (average 9 years). Results 20 (48.8%) of the 41 hips suffered from hip pain, 18 (43.9%) of the them were painlessness, and 3 (7.3%) of the them were discomfort. Without special treatment, 9 (22.0%) of the 41 hips collapsed, 8 of them were type B and one was type A. At the last follow-up, the collapse of the nine hips were without apparent progress. At the most recent follow-up, the thirty patients had good daily hip function, 39 (95.1%) of the 41 hips were asymptomatic and only 2 (4.9%) of them were discomfort. ConclusionsThis study demonstrates that the ARCO stage II femur head necrosis with ring-shaped hardening zone at the middle of femoral head (stay away from the weight-bearing area) which called type A by our team have a low frequency of collapse. Surprisingly, we found that regardless of type A or type B, whether or not collapse occurred, the stage-II femur head necrosis with ring-shaped hardening zone has a good prognosis without special treatment.