A novel direct anterior approach for the treatment of pediatric femoral neck fractures

Purpose The most common treatment method for femoral neck fractures (FNFs) has been closed reduction and fixation, although open reduction is sometimes inevitable. This research introduces a new direct anterior approach (DAA) for the treatment of FNFs, aiming to establish its feasibility for FNF reduction. Methods A retrospective study was performed on 24 patients (25 sides) with FNFs treated with open reduction from February 2017 to January 2023 in hospital. The patients comprised 17 males and 7 females, with 4 of them having type I fractures, 15 (16 sides) having type II fractures, and 5 having type III fractures. The patients were divided by surgical approach: Group A (Smith–Peterson/Watson–Jones), Group B (DAA). Postoperatively, a hip spica cast or plaster immobilization was applied and removed after six weeks. Weight-bearing on the affected side was avoided for three months after surgery, and internal fixation was removed six months after surgery. An MRI was then performed to examine for avascular necrosis (AVN) of the femoral head. Results Significant differences were observed in the incision length, operation time, and blood loss between Group A and B. All 24 patients were followed up for 6–36 months, with good hip joint function reported. In Group A, three patients experienced femoral head necrosis, resulting in a higher incidence of femoral head necrosis compared to Group B. Conclusions The DAA approach can be adopted for pediatric patients with FNF who require open reduction. Level of Evidence III