Background: Few studies have directly compared plate fixation and screw fixation in treating pediatric femoral neck fractures. The present systematic review compared the postoperative outcomes associated with these 2 fixation methods.
Methods: The PubMed, EMBASE, Cochrane Library, and Google Scholar databases were searched for articles reporting the outcomes of using plate fixation and screw fixation to treat femoral neck fractures in pediatric populations. Surgical outcomes were evaluated in terms of functional assessments and postoperative complications.
Results: This review included 31 studies involving 950 pediatric femoral neck fracture cases. The Ratliff criteria for functional assessments were comparable between the plate fixation and screw fixation groups. Plate fixation showed a reduced incidence of postoperative avascular necrosis and premature physeal closure compared with screw fixation. In addition, the incidence of coxa vara was slightly higher in the plate fixation group, although the nonunion and leg length discrepancy rates were similar between the screw fixation and plate fixation groups. Moreover, the results of subgroup analyses indicated that plate fixation reduced the risk of avascular necrosis and leg length discrepancy in patients with Delbet III/IV fractures and displaced fractures than screw fixation was.
Conclusion: Plate fixation may be a superior option because it showed a reduced risk of postoperative avascular necrosis and premature physeal closure, particularly in patients with Delbet type III/IV or displaced fractures.
Level of evidence: Level III-systematic review of retrospective comparative studies and case series.
Keywords: avascular necrosis; complication; pediatric femoral neck fracture; plate; screw.
Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc.