Complications after tibial tubercle traction and femoral neck fractures in children: a case report

ABSTRACT

Background: Genu recurvatum and femoral neck fracture in children are very rare, and relevant literaturewas reported. However, there were no reports on avascular necrosisafter internal fixation of femoral neck fractures in children, and genu recurvatum and tibial dysplasia after tibial tubercle traction.

Case presentation: In this case, a 32-year-old female patient suffered from a femoral neck fracture at the age of 10. The tibial tubercle traction was applied in the conservative treatment, and closed reduction and internal fixationwere adopted after the failure of the conservative treatment. When the patient came to our hospital for the treatment of hip and knee joint pain for 20 years, the doctor discovered that the patient had severe genu recurvatum and avascular necrosis. We adopted staged treatment for the patients. First, the left hip artificial joint replacement was performed due to the femoral head necrosis. After the operation, the pain in the left hip disappeared. Three months later, the patient underwent the combination of tibial osteotomy and tibial tubercle transposition to treat genu recurvatum. One year after the operation, the anterior and lateral radiographs of the knee joint displayed that the osteotomy area healed well, without complications such as fracture nonunion and infection. The appearance of the knee joint returned to normal. According to UCLA Activity Score and WOMAC (The Western Ontario and McMaster Universities) Osteoarthritis Index, the patient's activity and function levels were assessed, and the postoperative scores were significantly improved compared with preoperative scores.

Conclusion: Pediatric Femoral Neck Fractures should be treated promptly with surgery and long-term follow-ups. Total hip replacement is an effective method for the treatment of end-stage femoral head necrosis. Meanwhile, tibial traction should be avoided for children with lower extremity fractures, because it may damage the tibial growth plate, thus leading to the early closure of the metaphyseal region in children, and genu recurvatum. The modified surgery for the treatment of genu recurvatum is simple to operate and can avoid patella Baja, so it has a strong healing ability in the osteotomy area. The results of the surgery technique were ideal in this case.P

KEYWORDS:

• Genu recurvatum
• tibial tubercle traction
• tibial dysplasia
• osteotomy

Declaration of financial/other relationships

The authors declare that they have no competing interests.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

ZL performed the surgery and provided guidance. FD and JL assisted the surgery and drafted the manuscript. All authors read and approved the final manuscript.

Ethics approval and consent to participate

The case was reviewed by the Clinical Trial Ethics Committee of the Affiliated Hospital of Southwest Medical University. It was waived as written consent and obtained from the patient.

Written and informed consent was obtained from the patient for publication of this article and any accompanying images. A copy of the written consent is available for review.

Additional information

Funding

This work was supported by the Applied Basic Research Project of Science and Technology Department of Sichuan Province [2020YJ0265], Sichuan University-Luzhou Government Strategic Cooperation Project [No. 2019CDLZ-17].