Neonatal Distal Femoral Physeal Fracture Requiring Closed Reduction and Pinning

Abstract

Neonatal physeal fracture of the distal femur is often difficult to diagnose. Timely and accurate diagnosis and appropriate therapy are critical in order to avoid permanent morbidity and dysfunction of the affected limb. We describe an infant in whom closed reduction and pinning were required in order to assure a good outcome.

Physeal separation and complete resorption of femoral head associated with chronic osteomyelitis of femoral diaphysis in a young child: rare case report

“…The lesson learned is to ensure that, whenever possible, complete and detailed preoperative imaging is obtained to make a correct preoperative diagnosis, which is fundamental in planning the appropriate surgical procedure. The literature reports computed tomography and MRI as useful imaging devices that can provide more detailed knowledge of the actual condition [10,18,19]. It is our opinion that a detailed MRI study would have been preferable over a computed tomography evaluation as it would have spared the young patient exposure to ionizing radiation and would have also provided greater details of the area's soft tissues.…”

“…Concomitant physeal fracture and infection are very uncommon [10], and a complete separation of an epiphysis is described as a rare complication of neonatal osteomyelitis or septic arthritis [15]. The literature appears to indicate the hip joint as the most common site of epiphyseal slip as well as the most common site involved in a neonatal septic process [15].…”

“…Physeal separations in neonates occur rarely [10][11][12][13][14] and femoral involvement in physeal separation may occur either proximally or distally [10]. Concomitant physeal fracture and infection are very uncommon [10], and a complete separation of an epiphysis is described as a rare complication of neonatal osteomyelitis or septic arthritis [15].…”

Neonatal distal femoral epiphyseal dislocation: an ultrasound diagnosis

“…The advent of high-frequency transducers allows the musculoskeletal system to be examined in fine detail, confirming epiphysis dislocation and in addition permitting simultaneous direct evaluation of the surface of osseous elements and soft-tissue structures. Thus, not only fractures but also concomitant articular fluid, hematomas, degree and direction of the epiphysis displacement, subperiosteal hemorrhages, and persisting malposition after repositioning can be rapidly detected [7]. Magnetic resonance imaging could be used to confirm the diagnosis of physeal fractures, but sonography is a considerably easier, cheaper, and radiation-free tool that does not require sedation [1].…”

Epiphysial Separation of Femoral Head Due to Undiagnosed Hip Septic Arthritis

“…Reduction and pin fixation have been reported as a treatment for epiphysial femoral head separation (18,19). Despite the rare case of association of osteomyelitis with epiphysial separation of femoral head in infants and children, this diagnosis should be considered by physicians for infants and children.…”