Abstract
Our patient presented with a double femoral head, that is, two separate heads with individual epiphyses, but a single contiguous metaphysis. Two similar cases had been described in the literature. The only common feature in these three cases is that they had open reduction for Developmental Dysplasia of the Hip (DDH) through an anterior approach. No other pathology was detected in these patients. A rabbit model was created in which the cartilaginous anlage of the rabbit femoral head was surgically split. After 2-4 weeks a bifid femoral head developed, mimicking that described in the literature. We suggest that inadvertent damage to the femoral head during surgery for DDH may in fact lead to the development of a bifid femoral head. Prior history of DDH should be considered when the isolated bifid femoral head is identified.
Highlights
Bifid femoral heads are an unusual and puzzling deformity
While the etiology of the deformity is unknown, Ferguson [1], Rossman [2] and Salter [3] proposed that since increased pressure or forced positions contribute to the development of avascular necrosis of the hip, a tight iliopsoas tendon, or focal necrosis through forced positions, may be responsible for the development of a bifid femoral head
We propose that the deformity may be related to damage to the ossific nucleus of the femoral head during surgery for Developmental Dysplasia of the Hip (DDH)
Summary
Bifid femoral heads are an unusual and puzzling deformity. While the etiology of the deformity is unknown, Ferguson [1], Rossman [2] and Salter [3] proposed that since increased pressure or forced positions contribute to the development of avascular necrosis of the hip, a tight iliopsoas tendon, or focal necrosis through forced positions, may be responsible for the development of a bifid femoral head. If a tight iliopsoas muscle is the major factor in producing a bifid femoral head the condition should be common in the cerebral palsy population. It has never been described in those patients.
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