Date: Thursday, April 03, 2003 1:13 AM
Subject: Femoral Neck Fracture - Neurofibromatosis
kindly opine on this 13 year old, who presented 1 1/2 year s/p history of fall, sustaining injury to his left hip region.
He was treated by bone setters up til now. He complains of pain in his left groin region, greater trochanteric region and a limp. Past history of a painless lump around the ankle, which was excised many years ago
On examination, he walks with considerable difficulty and a painful limp. There is visible soft tissue swelling from lateral to medial malleolus with circumferential enlargement of the limb. His left greater trochanter lies approx. 2 cm proximal to the level of the right one. Measurements reveal 2 cm of shortening from ASIS to the knee, compared to opposite side. The tibia on the left is 7 cm longer than the opposite side. There is fixed flexion of 20 deg at the hip which has 20-70 deg range through all other movements, severly restricted. Multiple cafe au lait spots on body. Xrays attached. Delbet's type 3 fracture, with malunion/?non union, with AVN of head, and acetabular changes. I have tried to get other views in abduction, adduction and rotation, but there seems to be no change in the position. Kindly suggest possible management options.
Dr. M. Amin Chinoy FRCS.