Pediatric patient with a bilateral Salter-Harris II fracture and slipped capital femoral epiphysis secondary to autosomal recessive osteopetrosis

• Published in: Die Orthopädie Vol. 51; no. 12; pp. 1015 - 1021
• Main Authors: Jaber, Ayham, Schwarze, Martin, Steinle, Verena, Götze, Marco, Hagmann, Sébastien
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer Medizin 01.12.2022
• Subjects: Child; Child, Preschool; Chiropractic Medicine; Conservative Orthopedics; Coxa Vara - diagnostic imaging; Female; Femoral Neck Fractures - diagnostic imaging; Fracture Fixation, Internal - methods; Humans; Kasuistiken; Medicine; Medicine & Public Health; Orthopedics; Osteopetrosis - complications; Slipped Capital Femoral Epiphyses - diagnostic imaging; Sports Medicine; Surgical Orthopedics; Traumatic Surgery; Femoral neck fracture; Growth plate; Osteosynthese; Osteotomie; Pathologic fracture; Pathologische Fraktur; Kongenitale Erkrankung; Osteotomy; Osteosynthesis; Wachstumsfuge; Congenital disease; Schenkelhalsfraktur
• ISSN: 2731-7145; 2731-7153
• DOI: 10.1007/s00132-022-04278-x

Treatment of femoral neck fractures secondary to osteopetrosis is an uncertain and puzzled decision. Experience in the treatment, especially in the pediatric population, is scarcely reported. The duration of conservative treatment is prolonged and poses the risks of non-union and development of coxa vara deformity. The recommended treatment is closed reduction and internal fixation; however, surgery on osteopetrotic bone is challenging due to defective bone marrow function, delayed consolidation and higher risk of intraoperative fractures. Slipped capital femoral epiphysis secondary to osteopetrosis is very rarely reported. This article presents the case of a 5-year-old female patient with rapidly deteriorating physical function due to bilateral proximal femoral Salter-Harris type II fractures with associated slippage of the growth plates secondary to confirmed autosomal recessive osteopetrosis. Operative treatment was performed in a tertiary level orthopedic center with closed reduction and internal fixation with cannulated screws. A loss of fixation with coxa vara deformity was seen on the left side 7 months postoperatively with increasing pain. A revision surgery with reosteosynthesis and a valgus osteotomy was thus performed which showed good subjective and objective results 1 year postoperatively with complete bony union.