Postoperative alopecia in children after orthopaedic surgery

To report the cases of postoperative alopecia encountered after orthopaedic surgery at a single-level I trauma pediatric hospital.

We report on 3 children who developed postoperative alopecia after an orthopaedic surgery. The chart review included demographics and independent variables including age, ethnicity, weight, sex, presence of coexisting medical conditions, type and duration of surgery performed, examination findings at presentation and diagnosis of alopecia, and outcomes were recorded. Inpatient and outpatient clinic notes, operative reports, and recorded vital signs were also reviewed.

Three children (2 female, 1 male) were noted to develop postoperative alopecia. The average age at surgery was 13.7 years (range, 12 to 16). There was no significant past medical history, and 2 of 3 patients had obesity as a comorbidity. The type of surgery included: 2 proximal femoral osteotomies with proximal femoral osteoplasties and 1 wide resection of a congenital tibia pseudarthrosis with contralateral vascularized fibular grafting and internal fixation. Mean surgical duration was 5.9 hours (range, 4.4 to 7.1), and no intraoperative episodes of hypotension (<50 mm Hg) or hypothermia (T<35.9°C) occurred. The patients presented 2 to 3 weeks after surgery with hair loss localized over the posterior portion of the head. All patients were noted to have hair regrowth within 8 to 12 weeks, with 1 patient fully recovered and 2 patients continuing hair regrowth at most recent follow-up.

Postoperative alopecia is an uncommon but usually self-limited complication that can occur in children undergoing orthopaedic surgery. Although rare, the treating physician should be aware of its occurrence and course, and appropriate padding of the head during surgery is advised.

Level IV--retrospective case series.