Determinants of Surgical Success in Pediatric Femoral Neck Fractures: A Systematic Review

Abstract

Introduction: Pediatric femoral neck fractures are uncommon injuries, with a global incidence of 1.7 cases per 100,000 children; however, they carry a high potential for morbidity due to the precarious vascular supply of the femoral head and skeletal immaturity. This study synthesizes the scientific evidence regarding functional outcomes and risk factors associated with postoperative complications. Methods: A qualitative-analytical systematic review was conducted following the PRISMA 2020 guidelines using the Web of Science and Scopus databases. Studies addressing surgical management in patients younger than 18 years were included (n = 801). Results: Anatomical reduction emerged as the most significant predictor of outcomes, with inadequate reduction markedly increasing the risk of avascular necrosis (AVN) (RR = 2.43). Dynamic fixation systems, such as the Femoral Neck System and headless compression screws, demonstrated superior union rates (8.5–10.5 weeks) and lower reoperation rates compared with locking plates, which showed failure rates of up to 15.4%. An injury-to-surgery interval exceeding 82.5 hours was identified as a critical threshold for the development of ischemia. Discussion: Therapeutic success requires balancing mechanical stability with preservation of vascular biology. Ultra-early surgery (<12 hours) does not reduce the risk of AVN and may compromise anatomical alignment. Intertrochanteric valgus osteotomy remains a reliable salvage procedure for nonunion. Conclusion: Perfect anatomical reduction decreases the risk of adverse events by 78%. Priority should be given to technical precision through the use of dynamic implants and standardized surgical approaches rather than extreme chronological urgency.