- [Home](https://ortopediaevolutiva.com/en) - [Pediatric Orthopaedics Blog — Dr. Priano](https://ortopediaevolutiva.com/en/blog) - Pediatric femoral neck fractures: plate versus screws # Pediatric femoral neck fractures: plate versus screws January 19, 2026 2 min read Edited and medically reviewed by [Dr. Daniele Priano](https://ortopediaevolutiva.com/en/about) ![Pediatric femoral neck fractures: plate versus screws](https://ortopediaevolutiva.com/blog-images/femoral-fracture-mobility-v1.webp) This English version is based on the original Italian article. For wording nuances, you can refer to the Italian version. ## In short, for parents - • Femoral neck fractures are rare in children and can have important complications. - • The review associates plates with less osteonecrosis and premature growth plate closure, but does not establish that plates are always superior to screws. - • Implant choice depends on the fracture, achievable reduction and individual patient; no implant eliminates every risk. Femoral neck fractures are rare in children, but they carry a high risk of complications, particularly avascular necrosis, premature physeal closure, coxa vara, and growth disturbances. A systematic review published in 2026 compared plate fixation with screw fixation, gathering 31 studies and 950 cases. [1] ## Functional Outcomes Overall, outcomes assessed with Ratliff criteria were similar between plate and screw fixation. [1] The difference primarily emerged in complications. ## Avascular Necrosis and Physeal Closure In the review, plate fixation was associated with a lower incidence of avascular necrosis and premature physeal closure compared to screws. [1] This association was particularly evident in subgroups with Delbet III-IV fractures and in displaced fractures. In these patients, plate fixation was also associated with a smaller [limb length discrepancy](https://ortopediaevolutiva.com/en/conditions/limb-length-discrepancy). [1] These findings are potentially useful in unstable fractures, where mechanical control of reduction plays an important role. ## Coxa Vara Coxa vara was slightly more frequent in the group treated with plate fixation. Non-union and overall limb length discrepancy, however, were similar between the groups. [1] Therefore, no implant eliminates the risk of complications. The quality of reduction, [fracture](https://ortopediaevolutiva.com/en/conditions/injuries-fractures) pattern, age, trauma energy, and initial vascular damage remain crucial. ## How to Interpret the Review The included studies are predominantly retrospective, and the evidence is classified as Level III. The choice of implant was not randomized: it is possible that plates and screws were used in different patients and fractures. [1] The review does not demonstrate that plate fixation is always superior. However, it suggests that, in displaced fractures or Delbet III-IV patterns, more stable fixation may be associated with a favorable profile for some of the most important complications. The decision remains linked to the fracture morphology, the achievable quality of reduction, and surgical experience. Disclaimer: This content is for informational purposes only and does not replace an individual clinical evaluation. References [1] Chen Y-P, Lin C-H, Hong C-K, Yao S-H, Chen C-H. Plate Versus Screw Fixation in Treating Pediatric Femoral Neck Fractures: A Systematic Review. J Pediatr Orthop. 2026 Jan 14. DOI: 10.1097/BPO.0000000000003207. PMID: 41532397. PubMed: [https://pubmed.ncbi.nlm.nih.gov/41532397/](https://pubmed.ncbi.nlm.nih.gov/41532397/) — DOI: [https://doi.org/10.1097/BPO.0000000000003207](https://doi.org/10.1097/BPO.0000000000003207) ## Complete injuries and fractures pathway This page is part of the paediatric injuries and fractures pathway. The main guide covers the overall picture and the warning signs. - [1 Overview: when an injury is urgent How growing bone behaves, what happens in the emergency room and when an orthopaedic review is useful.](https://ortopediaevolutiva.com/en/conditions/injuries-fractures) - [5 Lower limb and ankle Femur, leg, knee and ankle: weight-bearing, healing times and return to walking.](https://ortopediaevolutiva.com/en/conditions/femur-fracture-children) [Leg](https://ortopediaevolutiva.com/en/conditions/leg-fracture-children) - [Ankle](https://ortopediaevolutiva.com/en/conditions/ankle-fracture-children) - [Knee injury](https://ortopediaevolutiva.com/en/conditions/knee-injury-children-adolescents) - [Tibial spine](https://ortopediaevolutiva.com/en/conditions/tibial-spine-fracture) - [Ankle surgery](https://ortopediaevolutiva.com/en/surgery/fractures/ankle) - [Foot surgery](https://ortopediaevolutiva.com/en/surgery/fractures/foot) - [6 Imaging, cast and follow-up Growth plate, follow-up X-rays and management of immobilization.](https://ortopediaevolutiva.com/en/conditions/physeal-fractures) - [7 Recovery and protocols How recovery works after injury or surgery; protocols are professional material.](https://ortopediaevolutiva.com/en/rehabilitation) ![Dott. Daniele Priano](https://ortopediaevolutiva.com/assets/doctor-avatar-3d-CTvqnoPa.webp) ### Concerned about your child? If you recognize any of these signs in your child, a specialist assessment can give you clarity. I see children at Gaetano Pini and CTO institutes in Milan. 5.0 · Google & MioDottore [Book a private visit](https://ortopediaevolutiva.com/en/locations#prenota) ### Related Conditions [Limb length discrepancy](https://ortopediaevolutiva.com/en/conditions/limb-length-discrepancy)[Fractures and trauma](https://ortopediaevolutiva.com/en/conditions/injuries-fractures) ### Related Surgery Pages [Limb length discrepancy treatment](https://ortopediaevolutiva.com/en/surgery/limb-length-discrepancy)[Fracture treatment](https://ortopediaevolutiva.com/en/surgery/injuries-fractures) ### Related Articles [Kirschner Wire Infection in Children: When Can It Become Osteomyelitis? Read](https://ortopediaevolutiva.com/en/blog/kirschner-wire-infection-children-osteomyelitis-risk)[Proximal humerus fracture in children: when is surgery really needed? Read](https://ortopediaevolutiva.com/en/blog/proximal-humerus-fracture-children-when-surgery-is-needed)[Growth plate fractures: why does follow-up continue after the bone has healed? Read](https://ortopediaevolutiva.com/en/blog/growth-plate-fractures-follow-up-after-healing) ![Dott. Daniele Priano](https://ortopediaevolutiva.com/assets/doctor-avatar-3d-BiLSxBxW.webp) Author and medical reviewer ## Dr. Daniele Priano [Pediatric orthopaedic care in Milan](https://ortopediaevolutiva.com/en) — Gaetano Pini & CTO [Read full bio](https://ortopediaevolutiva.com/en/about) --- Canonical: https://ortopediaevolutiva.com/en/blog/pediatric-femoral-neck-fractures-plate-or-screws Le informazioni cliniche sono divulgative e non sostituiscono una valutazione medica diretta.