Wagner Technique of Transphyseal Proximal Femoral Fixation

Abstract

Proximal femoral fractures and deformities in children are often difficult to treat because of high complication rates and risk of physeal closure resulting from the treatment fixation. The Wagner technique of smooth pin fixation through the femoral neck and across the proximal femoral physis provides stable fixation of the femoral neck and reduces the risk of avascular necrosis and growth disturbance. Eighteen consecutive cases in which the Wagner technique was used were reviewed. Diagnoses included fixation after proximal femur osteotomy, slipped capital femoral epiphysis reduction with associated valgus-producing osteotomy secondary to pre-existing coxa vara, traumatic femoral neck fractures, and pathologic femoral neck fractures secondary to aneurysmal bone cyst, unicameral bone cyst, fibrous dysplasia, or osteomyelitis in which bone defects were bone grafted before fixation. Outcomes included proximal femoral physeal closure, avascular necrosis (AVN), maintenance of alignment, and need for revision or implant removal surgery. There was no AVN, unintended proximal femoral physeal closure, or loss of fracture alignment requiring revision surgery. One patient required revision to an antegrade femoral nail for correction of progressive varus deformity. Four required implant removal: 2 because of continued growth and need for prophylaxis, 1 because of patient preference, and 1 for infection. Revision curettage and fixation was required for 1 of 10 patients with cyst recurrence after fixation for a pathologic femoral neck fracture. The Wagner technique is a versatile, safe, and effective method of transphyseal fixation for pediatric femoral neck fractures or proximal femoral deformity correction. In this series, there were no cases of AVN, premature unexpected proximal femoral physeal closure, or fracture malalignment requiring revision.