Traumatic transepiphyseal fracture of the femoral neck in early adolescence

Abstract

Acute traumatic fractures of the femoral neck in children and adolescents with a separation of the upper femoral epiphysis are very rare. Due to the vulnerability of the supplying femoral circumflex artery the prognosis is bad, with avascular necrosis and coxa vara leading to permanent deformity. We describe a case of a 12-year-old boy who sustained a left transepiphyseal fracture with complete separation (Delbet's type I) of the femoral head at the epiphysis. Reduction was achieved under general anaesthesia, capsular haematoma was removed and the displaced epiphyseal fragment was fixed by Kirschner wires. To guarantee a fast recovery of the blood supply for the femoral head an immediate and cautious treatment in this rare fracture type is proposed. If closed reduction is insufficient, only minor traumatizing techniques such as Kirschner wires should be used for the fixation of the epiphyseal fragment in ordner not to cause more intracapsular pressure.