Abstract
Abstract: Dealing with peri-articular pathology in the skeletally immature is challenging. Where the process is benign the emphasis rests on preservation of the joint while minimising the risk of recurrence. However when dealing with lesions of the femoral head this may lead to avascular necrosis (AVN), negating the effects of conservative surgery, and potentially subjecting a child to a prolonged period of fruitless treatment, increased hospital stay, reduced mobility and significant time out of education and social interaction. Case & Method: A 13 year-old Caucasian female presented with a six-month history of pain in her right hip, initially in the groin, and a limp necessitating the use of crutches. Radiographs revealed a lytic lesion in the femoral head with a thinned but intact articular surface. This was biopsied, and a diagnosis of chondroblastoma reached. The operative alternatives of arthrodesis and arthroplasty were discarded in preference for hip salvage. An anterior approach to the hip, with dislocation of the femoral head allowed identification of the fragile cortical margin of the chondroblastoma. This was opened with a scalpel and curetted. Corticocancellous strips of bone graft were placed into the defect as struts around cancellous graft. An autogenous fascia lata graft was sutured over the articular defect in the femoral head. The capsule was repaired. Results: One year post-operatively she is pain free and has returned to normal activities. Radiographs show good incorporation of the bone graft. Conclusion: Femoral head preservation is effective with benefits outweighing the risk of AVN.
Theses abstracts were prepared by Professor Dr. Frantz Langlais. Correspondence should be addressed to him at EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
