Abstract
Isolated femoral neck lesions in children are rare and the differential diagnosis is wide. This study examines the spectrum of chronic non-traumatic bone lesions seen in the femoral neck region in children and emphasises the importance of tissue diagnosis.
From 1990 to 2003, 23 children aged 1 to 3 years with chronic bone lesions of the femoral neck region were seen. Their case records and radiographs were reviewed retrospectively. Pain and a limp for 4 to 12 weeks were the main symptoms. Most children (18) had right-sided lesions. All had routine blood investigations, radiographs and bone scans. Histological and microbiological studies were done when pus and granulation tissue were found.
We found infections, benign tumours and haematopoetic lesions. There were seven cases of tuberculosis and three of subacute pyogenic osteomyelitis. Six children had simple bone cysts, one a chondroblastoma, one a fibrous dysplasia and three osteoid osteoma. Two had eosinophilic granulomata. All 23 lesions were treated by curettage and biopsied. Bone graft was used in all the simple bone cysts, fibrous dysplasia and chondroblastoma. Internal fixation was used in one displaced fracture and the rest were immobilised in a spica. Follow-up ranged from 9 months to 8 years. All lesions showed healing. Coxa vara occurred in four patients and growth disturbances in five.
Tuberculous lesions caused the greatest diagnostic dilemma as they resembled several benign bony conditions. Thorough examination is essential and biopsy is mandatory.
Secretary: Dr H.J.S. Colyn, Editor: Professor M.B.E. Sweet. Correspondence should be addressed to SAOA, Box 47363, Parklands, Johannesburg, 2121, South Africa.
