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. [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 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/ — DOI: https://doi.org/10.1097/BPO.0000000000003207
