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Honjo T, Okamoto T. Simultaneous Bilateral Femoral Neck Fractures in a Pediatric Patient Attributed to Epilepsy Convulsion: A Case Report. J Orthop Case Rep 2023; 13:101-105. [PMID: 37654768 PMCID: PMC10465742 DOI: 10.13107/jocr.2023.v13.i08.3834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/11/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction Bilateral femoral neck fractures are rare among children. Although several case reports have been published, fractures caused by epilepsy attacks in children have not been reported in the literature. This is the first report of simultaneous bilateral femoral neck fractures in a pediatric patient with epilepsy convulsions. Case Report This is a case of a child with bilateral femoral neck fractures caused by epileptic seizures. A 13-year-old Japanese boy had an epileptic seizure and was admitted to our hospital. The patient complained of bilateral thigh pain. Plain radiography revealed a bilateral femoral neck fracture. Conclusion The patient's simultaneous bilateral femoral neck fractures were successfully managed with closed reduction and internal fixation, a careful postoperative course, and ultrasound fracture therapy. Despite the delay in diagnosis, bone union was confirmed 6 months postoperatively. Pediatric bilateral femoral neck fractures without a history of trauma are rare and likely to be missed. This case was a teachable experience highlighting the importance of being vigilant about fractures in children with postepileptic seizures.
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Affiliation(s)
- Takashi Honjo
- Department of Orthopedic Surgery, Otsu Red Cross Hospital, Otsu, Japan
| | - Takeshi Okamoto
- Department of Orthopedic Surgery, Otsu Red Cross Hospital, Otsu, Japan
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Naik P, Mantri N, Tank P, Bhesaniya R. Bilateral Fracture Neck Femur in Child with Bilateral Delayed Union and Bilateral AVN: A Rare Occurrence and Literature Review. Indian J Orthop 2021; 55:501-507. [PMID: 34306567 PMCID: PMC8275697 DOI: 10.1007/s43465-021-00388-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/23/2021] [Indexed: 02/04/2023]
Abstract
A bilateral neck of femur fracture in children is a rare occurrence with only twelve cases reported till the date. We report a case of a 3-year-old schoolgirl with bilateral Delbet type 2 fracture neck femur after a fall from height. She was managed elsewhere by bilateral closed reduction and screw fixation within 24 h. She presented to us three months after surgery with painful hip movements and inability to walk. Her X-ray showed bilateral Ratliff type three avascular necrosis and bilateral delayed union with visible fracture lines. We placed her in double hip spica for three months. Fortunately, on both sides fractures united well with complete resolution of avascular changes. At one year follow-up, she had no functional limitation, no limb length discrepancy, and an x-ray showed mild coxa vara on left. Bilateral delayed union and avascular necrosis of fracture neck femur has not been reported till date.
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Affiliation(s)
- Premal Naik
- Rainbow Super-Speciality Hospital, Children’s Orthopaedic Centre, Next to Asia School, Behind HDFC Bank, Opposite Drive In Cinema, Bodakdev, Ahmedabad, Gujarat 380 054 India ,Honorary Pediatric Orthopedic Surgeon, Smt SCL Hospital, NHL Municipal Medical College, Ahmedabad, Gujarat India
| | - Nihit Mantri
- Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra India
| | - Parag Tank
- Honorary Pediatric Orthopedic Surgeon, Smt SCL Hospital, NHL Municipal Medical College, Ahmedabad, Gujarat India
| | - Ravi Bhesaniya
- B J Medical College, Civil hospital, Ahmedabad, Gujarat India
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Small I, Efrati R, Agar G, Keidan T, Bar Ziv Y, Shohat N. The Missing Piece: A Subtrochanteric Hip Fracture Presenting with Abdominal Pain: A Case Report. JBJS Case Connect 2020; 10:e19.00192. [PMID: 32649160 DOI: 10.2106/jbjs.cc.19.00192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 33-year-old man presented with acute abdominal and left hip pain after being struck by a motor vehicle. Radiographs revealed a comminuted left subtrochanteric femoral fracture. Computed tomography demonstrated a large pelvic hematoma and a radiopaque mass in the abdomen. Laparoscopy revealed the mass to be a large bone fragment lying within the greater omentum. The bone fragment, which seemed to be a femoral fracture fragment, was removed, and the fracture was repaired with a short cephalomedullary nail. CONCLUSION Rarely, subtrochanteric fracture fragments can penetrate the pelvis or abdomen because of high-energy trauma. Recognizing this possibility is important to assure a correct diagnosis and subsequent treatment.
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Affiliation(s)
- Ilan Small
- Department of Orthopaedic Surgery, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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Abstract
In the pediatric population, femoral neck fracture is a relatively uncommon injury with a high complication rate, despite appropriate diagnosis and management. The anatomy and blood supply of the proximal femur in the skeletally immature patient differs from that in the adult patient. Generally, these fractures result from high-energy trauma and are categorized using the Delbet classification system. This system both guides management and aids the clinician in determining the risk of osteonecrosis after these fractures. Other complications include physeal arrest, coxa vara, and nonunion. Multiple fracture fixation methods have been used, with the overall goal being anatomic reduction with stable fixation. Insufficiency fractures of the femoral neck, although rare, must also be considered in the differential diagnosis for the pediatric patient presenting with atraumatic hip pain.
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Scott B, Taylor B, Shung JR, Nimityongskul P. Bilateral femoral neck fractures associated with complex pelvic ring injuries in a pediatric patient: a case report. J Pediatr Orthop B 2017; 26:350-357. [PMID: 27509482 DOI: 10.1097/bpb.0000000000000375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED Femoral neck and pelvic fractures are rarely encountered in the pediatric population secondary to the resilient nature of the immature skeleton. Both fracture types usually result from high-energy blunt trauma including motor vehicle collisions, motor vehicle-pedestrian accidents, and falls from height. Considerable studies have been published on the natural history, management, and complications of pediatric pelvis and femoral neck fractures. However, few case reports have documented both fracture types in the same patient. Management of concomitant injuries presents unique challenges both for operative stabilization and for clinical postoperative care. After appropriate consent was obtained, a thorough review was performed of the patient's hospital records and imaging history. The senior author of the report also provided insight into the management of the patient's initial injuries and subsequent complications. Our case involves a 4-year-old female who was overrun by an all-terrain vehicle. Her orthopedic injuries included a nondisplaced Delbet type 3 fracture of the right femoral neck, a completely displaced Delbet type 3 fracture of the left femoral neck, bilateral sacroiliac fracture-dislocations, severe comminution of her left pubic rami, and a free-floating right pubic rami segment spanning from the triradiate cartilage to the pubic symphysis with severe rotational deformity. Her postoperative recovery was complicated by refracture of her left femoral neck (Delbet type 1), left hip osteomyelitis, and left femoral head avascular necrosis. The salient features of her operative management, subsequent complications, and functional recovery are described in this report. Cases of bilateral femoral neck fractures and multiple pelvic fractures in pediatric patients are sparsely documented in the literature because of their infrequent occurrence. Pediatric pelvic fractures typically do well with conservative treatment secondary to the incredible remodeling ability of the immature pelvis. Femoral neck fractures, in contrast, are highly associated with complications including coxa vara, nonunion, infection, physeal closure, and avascular necrosis. This case report documents two rare fracture types in the same patient and describes the challenges encountered throughout the duration of her recovery. LEVEL OF EVIDENCE Level V, Case report.
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Affiliation(s)
- Brandon Scott
- Department of Orthopaedic Surgery, University of South Alabama, Mobile, Alabama, USA
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Berger E, Chen L, Sun Z, Sun Z. A probable case of Legg-Calvé-Perthes disease in Warring States-era China. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2017; 16:27-30. [PMID: 28290307 DOI: 10.1016/j.ijpp.2016.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/24/2016] [Accepted: 11/06/2016] [Indexed: 06/06/2023]
Abstract
Reports of Legg-Calvé-Perthes disease (LCPD) in the paleopathological literature are rare. Here, the authors present a probable case of LCPD, which presents as abnormal morphology of the proximal femur. The condition was observed in an individual of the Warring States period in Shaanxi Province, China, and the morphology involves a "mushroom head" deformity of the proximal right femur and an enlarged acetabulum, along with a contralateral tibia, talus, and navicular that are enlarged and demonstrate periosteal new bone formation. The authors consider tuberculosis, septic arthritis, trauma, slipped capital femoral epiphysis, and Legg-Calvé-Perthes disease in a differential diagnosis. The authors conclude that the most likely diagnosis for the deformity is Legg-Calvé-Perthes disease. Bony changes in the hip joint and contralateral lower leg suggest that the individual had an altered gait because of the condition.
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Affiliation(s)
- Elizabeth Berger
- University of North Carolina at Chapel Hill Department of Anthropology, 301 Alumni Building, CB#3115, UNC-CH, Chapel Hill, NC 27599, USA.
| | - Liang Chen
- Northwest University School of Cultural Heritage, 229 Taibai North Road, Xi'an, China
| | - Zhouyong Sun
- Shaanxi Provincial Archaeological Research Institute, 31 Leyou Road, Yanta District, Xi'an, China
| | - Zhanwei Sun
- Shaanxi Provincial Archaeological Research Institute, 31 Leyou Road, Yanta District, Xi'an, China
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Li H, Zhao L, Huang L, Kuo KN. Delayed Slipped Capital Femoral Epiphysis After Treatment of Femoral Neck Fracture in Children. Clin Orthop Relat Res 2015; 473:2712-7. [PMID: 25427426 PMCID: PMC4488190 DOI: 10.1007/s11999-014-4067-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 11/14/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Slipped capital femoral epiphysis (SCFE) after the treatment of femoral neck fracture is a rare entity in children that poses important treatment challenges. CASE DESCRIPTION We describe the presentation and management of two patients, a 12-year-old girl and a 6-year-old girl, each of whom developed SCFE at 5 months and 9 months, respectively, after operative treatment of femoral neck fracture. LITERATURE REVIEW Five similar cases have been reported in the literature. Along with our two case studies, the average age of all seven patients was 8.9 years (range, 3.6-12 years; boys, 8.9 years; girls, 9 years). None of the children was in a high weight percentile or had any known endocrinologic disorder. Two had asymptomatic mild SCFE, whereas the others felt unexplained pain with ambulation when the slippage was brought to their attention. Although it is not possible to prove a causal relationship between the initial fracture and the subsequent SCFE, clinical factors such as implant irritation, early return to weightbearing, delayed union or nonunion, coxa vara, and avascular necrosis warrant consideration as potentially related to the subsequent slip. CLINICAL RELEVANCE The onset of SCFE after surgical treatment of a femoral neck fracture may reflect inadequate treatment of the fracture. For best practice, we should perform a gentle anatomic reduction, appropriate internal fixation for femoral neck fracture in skeletally immature patients. Postoperative cast immobilization and delayed weightbearing are also important to avoid complication. It is essential for pediatric orthopaedic surgeons to be aware of this clinical scenario to allow prompt recognition and patient treatment.
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Affiliation(s)
- Hai Li
- />Department of Pediatric Orthopaedics, Xin-Hua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092 China
| | - Li Zhao
- />Department of Pediatric Orthopaedics, Xin-Hua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092 China
| | - Luyu Huang
- />Department of Orthopaedic Surgery, Xi-Jing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Ken N Kuo
- />Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL USA
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Finnegan MA. CORR Insights®: Delayed Slipped Capital Femoral Epiphysis After Treatment of Femoral Neck Fracture in Children. Clin Orthop Relat Res 2015; 473:2718-20. [PMID: 25604872 PMCID: PMC4488220 DOI: 10.1007/s11999-014-4125-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 12/22/2014] [Indexed: 01/31/2023]
Affiliation(s)
- Maureen A. Finnegan
- Department of Orthopaedics, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-8883 USA
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Jacobson NA, Feierabend SP, Lee CL. Management of Cannulated Screw Failure and Recurrent SCFE Displacement - Case Report. J Orthop Case Rep 2014; 4:28-31. [PMID: 27298941 PMCID: PMC4722563 DOI: 10.13107/jocr.2250-0685.144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: SCFE occurs in 10 per 100,000 in some regions of the United States with the incidence continuing to increase. Percutaneous screw fixation is a well-accepted treatment for this disorder for over 20 years but management of complications is not well elucidated in the literature. Case Report: We describe a case where a traumatic unstable SCFE that was initially treated with closed reduction and fixation with a single transphyseal screw went on to hardware failure with recurrence of the deformity. The complication was successfully treated with closed reduction and re-cannulating the fractured screw within the epiphysis and extracting it using a conical extraction screw commonly referred to as an “easy out.” Three trans physeal screws were then placed for improved fixation strength. Follow-up at 9 months demonstrates a fused physis and no signs of avascular necrosis of the femoral head. Conclusion: Percutaneous management of SCFE screw breakage is possible utilizing specialized instruments and a precise and gentle manipulation preventing the need for more invasive treatments with their obligatory potential complications profile.
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