Gunshot injury of the proximal femoral physis.
A 12-year-old boy sustained a gunshot injury to the proximal femur. The bullet hole passed through the femoral neck very close to the proximal femoral physis (Ogden type 8 physeal injury) without neurovascular injury. The boy was treated conservatively with antibiotics and bedrest. Nine months later, avascular necrosis of the femoral head (Ratliff type 2) and limb shortening of 2 cm had developed. For this reason, a valgus intertrochanteric osteotomy was performed 1 year after the injury. However, only partial revascularization of a necrotic femoral head segment occurred. For the residual necrotic segment in the weight-bearing area and progressive shortening of the femur 3.5 years after injury, a valgus-extension intertrochanteric osteotomy was performed and remodelling of the necrotic fragment done. The boy is now over 19 years old. He has only minimal pain after sports activity and a slightly limited range of movement. The limb shortening is 1.5 cm.
Bartonícek
Jan
J
Orthopaedic Department of 3rd Faculty of Medicine, Charles University, Srobárova 50, 10034 Prague 10, Czech Republic. bartonic@fnkv.cz
Havránek
Petr
P
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D005265:Femoral Neck Fractures / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005271:Femur Head Necrosis / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D007103:Immobilization; D015601:Injury Severity Score; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D010027:Osteotomy / Q000379:methods; D020127:Recovery of Function; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000150:complications
D000900:Anti-Bacterial Agents