A Transepiphyseal Fracture of the Femoral Neck in a Child With 2 Widely Displaced Salter-Harris III Fragments of the Capital Femoral Epiphysis

Abstract

To our knowledge, this is the first report of a transphyseal fracture of the femoral neck with a fracture of the capital femoral epiphysis involving 2 widely displaced Salter-Harris III fragments in a child. Preoperative surgical lateral radiographs of the hip of a 14-year-old boy clearly showed an anteriorly dislocated femoral head fragment. However, the overlapping ischium, soft tissue, and an anteriorly dislocated femoral head fragment caused a posteriorly dislocated fragment of the split femoral head to be overlooked on the radiographs. The emergent nature of the injury resulted in the performance of an open reduction without further imaging studies. Based on the initial evaluation, an anterior iliofemoral approach was chosen, which made it difficult to locate the posteriorly dislocated main fragment of the split femoral head. This case highlights that plain radiographs do not always provide adequate information for such injuries. Computed tomography or magnetic resonance imaging should be employed to enable accurate diagnosis and appropriate treatment for fracture-dislocations of the pediatric hip.

The clinical features, management options and complications of paediatric femoral fractures

“…Plain anteroposterior (AP) and lateral radiographs of the affected femur are usually sufficient for initial diagnosis [14], but there should be a low threshold for obtaining either CT or MRI to define the pattern of femoral neck fractures and this is fundamental to planning the surgical approach and stabilisation in fractures with intra-articular extension [25].…”

Fracture-dislocation of the sacroiliac joint with severely unstable fractures of the pelvis and femur in a 16-month-old patient: a case report

“…In addition to being helpful in determining the need for surgery and assisting in surgical planning [19], CT is imperative in pediatric pelvic fracture cases to identify associated injuries. Scans of the hip to identify triradiate cartilage injuries are of particular importance, because such damage can result in premature growth-plate fusion, which can affect acetabular diametric growth [20].…”