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Osteonecrosis following isolated avulsion fracture of the greater trochanter in children. A report of two cases.

2003; National Institutes of Health; Volume: 85; Issue: 10 Linguagem: Inglês

Michael R. OʼRourke, Stuart L. Weinstein,

Hip and Femur Fractures

Isolated avulsion fracture of the greater trochanter is a rare condition in both adults and children 1-3. Injury to the proximal part of the growing femur has been associated with osteonecrosis of the epiphysis and metaphysis, particularly with epiphyseal separation and fracture of the femoral neck 4-6. The blood supply to the proximal femoral epiphysis has been well described by Trueta 7, Chung 8, and Ogden 9. Injury to the vulnerable posterolateral branches of the medial femoral circumflex artery has been implicated in the development of necrosis as a result of direct trauma, compression from an intracapsular hematoma, and iatrogenic injury during treatment 4-6,10-13. Kaweblum et al. 11 reported the case of a twelve-year-old child in whom treatment of an isolated avulsion fracture of the trochanter with open reduction and internal fixation resulted in osteonecrosis of the femoral epiphysis. We report the cases of two patients in whom osteonecrosis of the femoral epiphysis developed following an isolated avulsion fracture of the greater trochanter. One of the patients had minimal displacement and was managed nonoperatively; the other patient underwent a closed reduction and percutaneous screw fixation. In both cases, the trochanteric fracture healed; however, osteonecrosis of the femoral epiphysis developed in both. Case 1. While playing football, a healthy thirteen-year and one-month-old boy sustained a displaced avulsion fracture of the left greater trochanter ( Fig. 1-A ), which initially was treated with closed reduction and percutaneous cannulated screw fixation ( Fig. 1-B ) at another institution. The postoperative course included protected weight-bearing for six weeks followed by a gradual return to activities. The patient did well and was able to play basketball during the ensuing winter months. The screws were removed five months after the …