Seizure-related bilateral asynchronous displaced late presenting Delbet type I fractures: A case report and literature review

Abstract

Delbet type I transphyseal hip fractures without dislocation are extremely rare injuries. This is the first report of a bilateral case caused by seizures. A 4-year-old girl with global developmental delay, who walks supported, fell off her bed during an epileptic fit. The parents presented two weeks later, and radiographs revealed a displaced right Delbet type I transphyseal upper femoral separation. Under general anesthesia, surprisingly, the physis was reduced anatomically using the Leadbetter maneuver. Fixation was carried out with three smooth Kirschner wires (KWs), after which uneventful healing occurred. Sixteen months following the first injury, the girl had another seizure, which resulted in a buckle fracture of her left distal femur. Unfortunately, an identical left hip physeal injury was missed. On presentation three months later, stress radiographs showed non-union of the physis. Fortunately, again, the Leadbetter maneuver succeeded in reducing the physis, which was fixed using two smooth KWs. She was seen one year following the left hip surgery (2.5 years after the right hip surgery), and the left physis had united with no ischemic necrosis on both sides. The patient then resumed her ability to walk supported and sit cross-legged. A telephone call to the father six years post-surgery to the right hip and four years and six months post-surgery to the left hip confirmed that she was asymptomatic and maintained her previous abilities. Because of the COVID-19 pandemic, she could not attend for clinical and radiographic examinations.