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Proximal femoral epiphysiolysis in the neonate
Insights
Proximal femoral epiphysiolysis in neonates presents with leg pain and radiographic findings mimicking hip dysplasia. Treatment with traction and splinting yields excellent results, though rare growth complications can occur.
Area of Science:
- Pediatric Orthopedics
- Neonatal Skeletal Development
- Pediatric Trauma
Background:
- Proximal femoral epiphysiolysis is a rare condition in neonates.
- Clinical presentation can mimic congenital hip dysplasia, complicating diagnosis.
- Understanding the injury mechanism is crucial for effective management.
Purpose of the Study:
- To review cases of neonatal proximal femoral epiphysiolysis.
- To analyze diagnostic findings, treatment outcomes, and complications.
- To elucidate the injury's morphology and pathogenesis.
Main Methods:
- Retrospective review of seven neonates with eight proximal femoral epiphysiolyses.
- Analysis of clinical presentation, radiographic findings, and arthrography.
- Evaluation of treatment modalities (traction, splinting) and long-term outcomes.
- Morphological study using stillborn cadavers and an animal model.
Main Results:
- Leg motion-induced pain was the primary diagnostic symptom.
- Radiography showed lateralization of the femoral shaft; acetabular index was mostly normal.
- Arthrography confirmed physeal injury with metaphyseal displacement.
- Traction and splinting led to excellent outcomes in most cases (6/8 fractures).
- Complications included angular deformity and coxa vara due to premature growth arrest in two cases.
- Cadaveric and animal models indicated a Type 1 physeal injury with potential medial comminution.
Conclusions:
- Proximal femoral epiphysiolysis in neonates is distinct from congenital hip dysplasia.
- Early diagnosis and appropriate management, including traction and splinting, are key.
- Understanding the injury's morphology helps explain potential long-term growth complications.
Abstract:
Seven neonates with eight proximal femoral epiphysiolyses were reviewed. Pain elicited by leg motion was the common diagnostic finding in all. Radiography showed lateralization of the shaft similar to congenital hip dysplasia. However, the acetabular index was normal in all but one child. Arthrography confirmed the diagnosis, showing a located proximal femoral epiphysis and a laterally displaced, externally rotated proximal metaphysis. Treatment usually consisted of traction followed by abduction splinting. The long-term results were excellent in six fractures. Growth complications included angular deformation (bowing) in one patient and coxa vara due to localized premature epiphysiodesis in one patient. Duplication of the lesion in stillborn cadavers showed that the fracture was usually a type 1 physeal injury traversing the entire physis beneath both the capital femur and the greater trochanter. The periosteal sleeve was intact posteriorly and still attached to the proximal physis. However, in two instances there was comminution (rather than crushing) of the epiphysis, physis, and metaphysis medially, which might explain the residual varus deformation and premature growth arrest seen infrequently as complications of this particular proximal femoral injury. An experimental animal model also duplicated these morphologic observations.