Department of Orthopaedic Surgery, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, Zhejiang, People's Republic of China.
Medicine (Baltimore). 2021 Jan 29;100(4):e23616. doi: 10.1097/MD.0000000000023616.
Pediatric femoral shaft combined with ipsilateral femoral neck fractures are very rare but challenging injuries fraught with the development of avascular necrosis, coxa vara, and leg length discrepancy. Majority of the previous reports indicated the neck femur fracture was fixed with cannulated screws or/and pins, femoral shaft fracture was stabilized with a plate and screws. However, we used cannulated screws combined with elastic stable intramedullary nails to minimally invasive procedures treat this type of injury and achieved good follow-up results.
A 7-year-old boy (Case 1) was hospitalized due to a traffic accident resulting in swelling and deformity of the right thigh accompanied by limited mobility of hip and knee. A 5-year-old male child (Case 2) presented with pain and swelling in the bilateral lower limb after fall from approximately 12 feet.
Physical examination, X-ray film, and computed tomography were performed. Both patients were diagnosed with ipsilateral femoral neck and shaft fracture.
The fractures were reduced closed by image-intensifier imaging. Two partially threaded cancellous screws were used to fix femoral neck fracture, and elastic intramedullary nails were performed to stable the femoral shaft fracture. Postoperatively, the patients were immobilized in a one-and-a-half hip spica cast for six weeks. The internal fixations were removed after one year.
Case one was follow-up at 14 months and the other one was followed up for 3 years. And at the last follow-up showed a normal and painless hip function. No clinical complications were found during follow-up visit, including head penetration, implant failure, fracture nonunion, avascular necrosis and hip varus deformity.
Clinician should carefully check and read relevant imaging data to avoid missed diagnosis. And the internal fixation method described in this paper may be more minimally invasive.
小儿股骨干合并同侧股骨颈骨折非常罕见，但治疗极具挑战性，容易发生股骨头缺血性坏死、髋内翻和肢体长度不等。既往大多数报道表明，股骨颈骨折采用空心螺钉或/和钢针固定，股骨干骨折采用钢板和螺钉固定。然而，我们使用空心螺钉联合弹性稳定髓内钉微创治疗此类损伤，取得了良好的随访结果。
一名 7 岁男孩（病例 1）因车祸致右大腿肿胀、畸形，伴髋关节和膝关节活动受限而住院。另一名 5 岁男性儿童（病例 2）从大约 12 英尺高处坠落，双侧下肢疼痛和肿胀。
进行体格检查、X 射线和计算机断层扫描。两名患者均被诊断为同侧股骨颈和股骨干骨折。
通过影像增强器进行闭合复位。采用 2 枚部分螺纹松质骨螺钉固定股骨颈骨折，弹性髓内钉固定股骨干骨折。术后，患者用单髋半环石膏固定 6 周。1 年后取出内固定物。
病例 1 随访 14 个月，病例 2 随访 3 年。末次随访时髋关节功能正常，无疼痛。随访期间未发现临床并发症，包括头穿透、植入物失败、骨折不愈合、股骨头缺血性坏死和髋内翻畸形。
临床医生应仔细检查和阅读相关影像学数据，避免漏诊。本文描述的内固定方法可能更微创。
