3D-guided high-degree posterior rotational osteotomy for avascular necrosis in pediatric femoral neck fractures: A three-case study

Purpose Pediatric femoral neck fractures (PFNFs) are rare (≈1% of pediatric fractures), and avascular necrosis (AVN) is a devastating complication without a universally accepted management. High-degree posterior rotational osteotomy (HDPRO) with three-dimensional (3D) navigation is a novel joint-preserving technique with the potential to improve outcomes.

Methods A retrospective case series was conducted with three pediatric patients (2 boys, 1 girl; aged 9-15 years at injury) diagnosed with AVN secondary to PFNF. All underwent HDPRO using Stryker OrthoMap 3D navigation to reposition the viable anteromedial femoral head. Preoperative and postoperative outcomes were assessed using radiographic analysis, functional scoring (Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ)), and sports participation. Follow-up ranged from 24 to 36 months.

Results All patients showed pain relief, functional improvement, stable femoral head morphology, and revascularization. JHEQ improved to 79-84 points; hip motion normalized without impingement. All patients returned to sports (track, volleyball, cycling).

Conclusions HDPRO with 3D navigation is a promising joint-preserving option for AVN following PFNF. Preliminary results are favorable; however, the small cohort and limited follow-up warrant larger studies.

Significance of study To the best of our knowledge, this is the first report demonstrating that navigation-guided HDPRO reliably relocates the viable anteromedial head to the load-bearing zone.

Level of evidence Level IV.