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Treatment of the femoral neck peudoarthrosis in childhood: Case report

Vukašinović Zoran (Medicinski fakultet, Beograd + Institut za ortopedsko­hirurške bolesti "Banjica", Beograd)
Šešlija Igor (Institut za ortopedsko­hirurške bolesti "Banjica", Beograd)
Pavlović Mladen (Institut za ortopedsko­hirurške bolesti "Banjica", Beograd)
Živković Zorica (Evropski univerzitet, Medicinska akademija US Medical School, Beograd + Kliničko­bolnički centar "Dr Dragiša Mišović", Beograd)

Introduction. Femoral neck fractures in children and adolescents are rare. However, their complications are frequent - avascular necrosis, femoral neck pseudoarthrosis, premature physeal closure with consequent growth disturbance and coxa vara deformity. Case Outline. A 9.5­year­old boy was injured in a car accident, and femoral neck fracture was diagnosed. Prior to admission at our hospital he was surgically treated several times. He was admitted at our hospital eight months following the accident. On the X­ray transcervical pseudoarthrosis of the femoral neck was found, as well as coxa vara deformity and metaphyseal avascular necrosis. He was operated at our hospital; all previously placed ostefixation material was removed, valgus osteotomy of 30 degrees was done as well as additional local osteoplasty using the commercial osteoindactive agent (Osteovit®). Postoperatively, we applied skin traction, bed rest and physical therapy. At the final follow­up, the patient was recovered completely. He is now painless, the legs are of equal length, range of movements in the left hip is full, life activity is normal. The X­ray shows that the femoral neck pseudoarthrosis is fully healed. Conclusion. This case is presented in order to encourage other colleagues to challenge the problematic situation such as this one. Also, we would like to remind them what one should think about and what should be taken into consideration in the primary treatment of femoral neck fractures in children. Valgus femoral osteotomy, as a part of the primary treatment of femoral neck fracture in children (identically as in the adults) can prevent the occurrence of femoral neck pseudoarthrosis.

Keywords: femoral neck, fracture, pseudoarthrosis, childhood