Abstract
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.
Similar content being viewed by others
References
Bartlett CS, Helfet DL, Hausman MR, Straus E (2000) Ballistic and gunshot wounds: effects on musculoskeletal tissues. J Am Acad Orthop Surg 8:21–36
Letts RM, Miller D (1976) Gunshot wounds of the extremities in children. J Trauma 16:807–811
Miclau T, Gerich T, Foglar C, Lindsey RW, Krettek C (2000) Behandlung von Schussverletzungen des Bewegungsapparates (gunshot wounds of the musculoskeletal system). Unfallchirurg 105:188–198
Ogden JA (2000) Skeletal injury in the child. Springer Verlag, Berlin Heidelberg New York, pp 188–190
Ratliff AHC (1974) Fractures of the neck of the femur in children. Orthop Clin North Am 5:903–924
Urbaniak JR, Harvey EJ (1998) Revascularization of the femoral head in osteonecrosis. J Am Acad Orthop Surg 6:44–54
Washington ER, Wayne AL, Ross WAJ (1995) Gunshot wounds to the extremities in children and adolescents. Orthop Clin North Am 26:19–28
Wright DG, Levin JS, Esterhai JL, Heppenstall RB (1993) Immediate internal fixation of low-velocity gunshot-related femoral fractures. J Trauma 35:678–682
Acknowledgement
The study was prepared with a grant of the Ministry of Health of the Czech Republic (grant IGA MZ ND 7022–3).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bartoníček, J., Havránek, P. Gunshot injury of the proximal femoral physis. Arch Orthop Trauma Surg 124, 69–71 (2004). https://doi.org/10.1007/s00402-003-0600-2
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-003-0600-2