Clinical and Radiological Outcomes of Pediatric Femoral Neck Fractures Treated with Surgical Internal Fixation: A Retrospective Case Series.

Introduction: Femoral neck fractures in children are rare injuries associated with a high risk of complications, particularly avascular necrosis (AVN) of the femoral head. The purpose of this retrospective study was to evaluate the functional and radiological outcomes of pediatric femoral neck fractures treated surgically and to assess factors influencing clinical outcomes. Materials and Methods: This retrospective, single-center study included 18 children (<16 years) with isolated unilateral femoral neck fractures who were treated surgically between January 2021 and September 2022. Fractures were classified according to the Delbet system. Internal fixation was performed using cannulated cancellous screws, Moore's pins, or a combination of both. Operative time, blood loss, and fluoroscopy exposure were recorded from operative records. Patients had a minimum follow-up of 1 year. Functional outcomes were assessed using Ratliff's criteria, and radiological evaluation included fracture union, loss of neck-shaft angle, and development of AVN. Given the rarity of the injury, the study was designed as a retrospective single-center observational case series. Results: Union was achieved in all but three cases. AVN of the femoral head was observed in three patients, predominantly in Delbet type I and II fractures. Functional outcomes tended to be more favorable in less proximal fracture types. No statistically significant association was found between implant type and functional outcome. Conclusion: Outcomes following internal fixation of pediatric femoral neck fractures appeared to be more closely related to fracture morphology and quality of reduction than to implant choice. These findings suggest that patient and fracture characteristics may play a greater role in determining outcomes than the fixation method used.