Longitudinal Management of Progressive Femoral Deformities in a Pediatric Patient: A Case Study on Adaptative Surgical Interventions and Outcomes

Abstract

Introduction: Pediatric femoral deformities present unique challenges in orthopedics, requiring careful management to accommodate ongoing growth and development in young patients. This case report illustrates the longitudinal treatment of a child who experienced multiple complications following an initial femoral neck fracture in a cystic lesion, highlighting the complexity of managing such conditions over time.

Case report: A 4-year-old child presented in 2016 with a femoral neck fracture and a cystic lesion in the proximal femur, initially managed with valgus osteotomy and dynamic compression plate fixation. Two years later, the patient exhibited a malunited fracture leading to coxa vara, which was managed by implant removal. In 2021, the child developed a bowing deformity which was corrected operatively with another osteotomy and TENS wire insertion. The most recent intervention in 2022 involved a valgus osteotomy and fixation with a dynamic hip screw to address persistent coxa vara, resulting in a successful union.

Conclusion: This case emphasizes the need for ongoing, adaptive management strategies in pediatric orthopedics, particularly for patients with complex femoral deformities. Each surgical intervention was tailored to the child's evolving anatomical needs, with close follow-up to ensure optimal outcomes as the patient grew. The multidisciplinary approach and continuous reassessment are critical in achieving favorable long-term results in similar pediatric cases.

Keywords: Pediatric orthopedics; coxa vara; dynamic hip screw; femoral deformities; longitudinal case study; surgical management; valgus osteotomy.

Figure 1

Initial pre-operative anteroposterior radiographs of the child with a cystic lesion in the proximal femur along with a pathological fracture in a 4-year-old child in 2016.

Figure 2

Initial pre-operative lateral radiograph of the child with a cystic lesion in the proximal femur along with a pathological fracture in a 4-year-old child in 2016.

Figure 3

Post-operative radiographs showing valgus osteotomy and fixation using a dynamic compression plate.

Figure 4

Follow-up radiographs in 2018, at the age of 6, the patient returned with a malunited femoral neck fracture with coxa vara deformity, along with the persistence of the cystic lesion.

Figure 5

In 2021, at the age of 9, the child developed a bowing deformity of the femur with the persistence of the cystic lesion.

Figure 6

Pre-operative planning for multi-level osteotomy to correct the bowing deformity of the femur.

Figure 7

Post-operative radiographs after multi-level osteotomy, which corrected the bowing deformity, and final follow-up at the osteotomy’s union.

Figure 8

Valgus osteotomy and fixation with DHS done in 2022 at the age of 10.

Figure 9

Final follow-up leading to successful union along with correction of coxa vara at age 12.