ArticleUlusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES2026
Two versus three cannulated screws in pediatric Delbet type II femoral neck fractures: a retrospective comparative study.
Article in Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPediatric femoral neck fractures are rare but carry a high risk of complications such as avascular necrosis (AVN), premature physeal closure, and coxa vara. Although stable internal fixation is essential, the optimal number of cannulated screws remains controversial. This study compares the clinical and radiological outcomes of two- versus three-screw fixation in a homogeneous cohort of Delbet type II fractures.
methodsThirty-six children treated within three days of injury and followed for at least five years were retrospectively analyzed. All fractures were fixed using either two or three cannulated screws. Surgical variables included reduction quality, screw number, physeal penetration, screw-to-neck area ratio, and the presence of cortical comminution. Patients were stratified into two age groups (<10 and ≥10 years). Complications-AVN, premature physeal closure, and coxa vara-were assessed radiographically and classified using established criteria. Statistical comparisons were performed using appropriate parametric and nonparametric tests.
resultsOlder children (≥10 years) showed higher rates of total complications, AVN, and physeal closure; however, the differences were not statistically significant. Medial or posterior cortical comminution significantly increased complication rates. Physeal penetration markedly elevated the risk of premature physeal closure (p=0.045). Reduction quality strongly correlated with outcomes, with unacceptable reductions associated with significantly higher rates of AVN and physeal closure. The number of screws did not significantly influence overall complications or specific adverse outcomes. The screw-to-neck area ratio showed a nonsignificant trend toward higher values in patients with complications.
conclusionAnatomical reduction and avoidance of physeal penetration are the primary determinants of postoperative outcomes in pediatric Delbet type II femoral neck fractures. When reduction is adequate and biological structures are preserved, the use of two or three screws yields comparable long-term results.
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