Pinning Versus Plating in Treatment of Fracture Neck Femur in Skeletally Immature Patients: A Systematic Review and Meta-analysis

Abstract

In the pediatric population, femoral neck fractures are a rare injury with frequent and serious complications, especially osteonecrosis, because of the vulnerability to injury of the end-arterial blood flow and of the osseous anatomy of the child’s proximal femur. Although debate exists on the management of these injuries in regard to surgical timing, surgical approach, and fixation, the goal of treatment remains unchanged: achieve fracture union and anatomic reduction while avoiding osteonecrosis. The Delbet classification provides insight on prognosis and guides treatment. Objective: To provide cumulative data about the efficacy and safety of pinning versus plating in treatment of fracture neck femur in skeletally immature patients. Data Sources: Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2018. Data Extraction: If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Conclusion: In our meta-analysis, we found that there is no significant difference (P-value > 0.05) in safety (complications rate and poor functional outcome) and efficacy (time required for union and good functional outcome) of using pinning or plating techniques for treating skeletally immature patients with fracture neck femur.