Skip to main content
SpringerLink
Log in

Proximal femoral physeal fractures in children: a rare abusive injury

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Background

Proximal femoral physeal fractures are rare in abused children. Recognition may be hampered due to their rarity and lack of an ossified femoral head. Prompt diagnosis and treatment are essential to preventing coxa vara.

Objective

To demonstrate the radiographic features of proximal femoral physeal fractures both with unossified and ossified femoral heads.

Materials and methods

We reviewed our Institutional Review Board-approved 21-year radiology database of 2,206 children who had a skeletal survey as part of their medical evaluation for possible abuse. Cases of proximal femoral physeal fractures were identified.

Results

Eight patients, ages 2.5 to 26 months, with 10 fractures were found, yielding a prevalence of 0.4% (8/2,206). In all fractures, there was lateral displacement of the proximal femur. In three fractures, the femoral head was not ossified, simulating a hip dislocation. The intra-articular location of the femoral head was verified by ultrasound or abdomen computed tomography. Subperiosteal new bone formation was present in six fractures, all non-weight-bearing patients. The femoral head was ossified in seven cases, all with medial rotation of the femoral head. Metaphyseal irregularity was present in three of four fractures of the weight-bearing patients; two of three also had metaphyseal scalloping resembling osteomyelitis. The three with metaphyseal irregularity developed coxa vara.

Conclusion

Proximal femoral physeal fractures are rare in abuse cases. All present with lateral displacement of the proximal femur. With an unossified femoral head, it can simulate hip dislocation, which can be clarified with hip sonogram. Metaphyseal irregularity appears to be a feature in weight-bearing patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Boardman MJ, Herman MJ, Buck B, Pizzutillo PD (2009) Hip fractures in children. J Am Acad Orthop Surg 17:162–173

    Article  Google Scholar 

  2. Theodorou SD, Ierodiaconou MN, Mitsou A (1982) Obstetrical fracture-separation of the upper femoral physis. Acta Orthop Scand 53:239–243

    Article  CAS  Google Scholar 

  3. Beals RK, Tufts E (1983) Fractured femur in infancy: the role of child abuse. J Pediatr Orthop 3:583–586

    Article  CAS  Google Scholar 

  4. Azouz EM, Karamitsos C, Reed MH et al (1993) Types and complications of femoral neck fractures in children. Pediatr Radiol 23:415–420

    Article  CAS  Google Scholar 

  5. Ogden JA, Lee KE, Rudicel SA, Pelker RR (1984) Proximal femoral epiphysiolysis in the neonate. J Pediatr Orthop 4:285–292

    Article  CAS  Google Scholar 

  6. Caterini R, Farsetti P, d’Arrigo C, Ippolito E (1991) Unusual physeal lesions of the lower limb. A report of 16 cases with very long-term follow-up observation. J Orthop Trauma 5:38–46

    Article  CAS  Google Scholar 

  7. Blockey NJ (1969) Observations of infantile coxa vara. J Bone Joint Surg Br 51:106–111

    CAS  PubMed  Google Scholar 

  8. Jones JC, Feldman KW, Bruckner JD (2004) Child abuse in infants with proximal physeal injuries of the femur. Pediatr Emerg Care 20:157–161

    Article  Google Scholar 

  9. Paris N, Journeau P, Moh Ello N et al (2008) Bilateral upper femoral physis injury in a case of epilepsy in a young child. Rev Chir Orthop Reparatrice Appar Mot 94:403–406

    Article  CAS  Google Scholar 

  10. Kleinman PK (2015) Diagnostic imaging of child abuse. United Kingdom, Cambridge

    Book  Google Scholar 

  11. Dwek JR (2010) The periosteum: what is it, where is it, and what mimics it in its absence? Skeletal Radiol 39:319–323

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Diagnostic Imaging and Radiology, Children’s National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA

    Eglal Shalaby-Rana

  2. Child and Adolescent Protection Center, Children’s National Hospital, Washington, DC, USA

    Tanya S. Hinds, Katherine Deye & Allison M. Jackson

Authors
  1. Eglal Shalaby-Rana
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tanya S. Hinds
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katherine Deye
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Allison M. Jackson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eglal Shalaby-Rana.

Ethics declarations

Conflicts of interest

None

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shalaby-Rana, E., Hinds, T.S., Deye, K. et al. Proximal femoral physeal fractures in children: a rare abusive injury. Pediatr Radiol 50, 1115–1122 (2020). https://doi.org/10.1007/s00247-020-04669-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-020-04669-2

Keywords

Search

Navigation