Delayed Separation of the Capital Femoral Epiphysis After an Ipsilateral Transcervical Fracture of the Femoral Neck

Abstract

A displaced transcervical fracture of the femoral neck in a three-year-eight-month-old boy was fixed with two screws, which did not cross the growth plate. When he resumed walking five weeks after the injury, a delayed separation of the capital femoral epiphysis occurred. The displaced epiphysis was reduced and fixed with three unthreaded pins. In spite of disruption of the femoral neck at two sites, avascular necrosis of the femoral head did not occur. This was confirmed by two sequential isotope scans. Delayed epiphyseal separation after the femoral neck fracture and the preservation of the vascularity of the epiphysis in this case are both very unusual.

Slipped capital femoral epiphysis after ipsilateral femoral neck fracture in an 11-year-old girl

“…We have been able to locate only two reports of this association. 5,12 The interval between the initial injury and the epiphyseal separation in the current case was only 5 weeks, and the physeal separation occurred immediately after the child resumed walking. This suggests that the causative factor was not prolonged repetitive loading of an abnormally inclined growth plate seen in the previously reported patient with the malunited femoral neck fracture.…”

“…[8][9][10][11] In the literature, delayed separation of the capital femoral epiphysis after a fracture of the femoral neck is very uncommon. 5,12 We report one such case, which went on to heal with evidence of avascular necrosis.…”

Delayed Slipped Capital Femoral Epiphysis After Treatment of Femoral Neck Fracture in Children

“…We reviewed the reports of five other patients who developed SCFE after surgical treatment of a femoral neck fracture [5,8,9,15,21] (Table 1); to our knowledge, these represent all of the published examples of SCFE after a surgically treated proximal femoral fracture. Along with our two patients, mean age of all seven patients was 8.9 years (range, 3.6-12 years; boys, 8.9 years; girls, 9 years).…”

“…However, it is difficult to prove a direct causal relationship because most children with femoral neck fracture do not have the complication of SCFE, and only seven cases have been reported to date that we know of, including the two we describe here. Nonetheless, in reviewing the treatment of the seven patients, some associations may plausibly be made, which we discuss in the subsequent section; these associations may include implant irritation, premature initiation of weightbearing, improper postoperative immobilization, delayed union or nonunion, coxa vara, and AVN [5,8,9,15,21]. One other possible associated factor is excessive retroversion with fixation for the fracture.…”

“…The occurrence of delayed SCFE after treatment of femoral neck fracture is another serious complication, although less common. To our knowledge, only five cases of delayed SCFE in the pediatric population have been reported in the literature [5,8,9,15,21].…”