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

• Published in: Journal of orthopaedic surgery and research 2023-01, Vol.18 (1), p.49-49, Article 49
• Main Authors: Lim, Eic Ju, Kim, Boo-Seop, Kim, Minboo, Shon, Hyun-Chul, Kim, Chul-Ho
• Format: Article
• Language: English
• Subjects: Child; Children; Closed reduction; Comparative analysis; Coxa Vara - complications; Coxa Vara - surgery; Femoral neck fracture; Femoral Neck Fractures - complications; Femoral Neck Fractures - surgery; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Internal - methods; Fractures; Humans; Internal fixation in fractures; Medical care; Open Fracture Reduction; Open reduction; Pediatric; Pediatrics; Plastic Surgery Procedures; Quality management; Retrospective Studies; Systematic Review; Treatment Outcome
• ISSN: 1749-799X; 1749-799X
• DOI: 10.1186/s13018-023-03525-x

The 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. MEDLINE, 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). We 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). Despite 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.