Fracture of the Femoral Shaft in a Patient with Proximal Femoral Focal Deficiency: Case Report
BRENT GRAHAM, MD, FRCS(C) ANDRICHARD D. BEAUCHAMP, MD, FRCS(S)
Patients with a markedly hypoplastic femur are susceptible to the same injuries as normal children. These may be overlooked and symptoms of proximal thigh pain may be attributed to prosthetic complications or soft tissue inflammation.
A boy presented deformity of the right lower limb noted at birth; radiographs identified an Aitken Class C proximal femoral focal deficiency.1 At 18 months, a Syme's amputation was performed and the patient was later fitted with an ischial-bearing prosthesis. He functioned well until the age of 6 years when he sustained an injury to the right leg from a fall from a couch. He was not wearing the prosthesis at the time. Although he had pain in the thigh he could ambulate using crutches without his prosthesis.
Owing to continuing pain in the thigh, he was brought to the hospital for evaluation ten days after his injury. Radiographs of the right thigh revealed an undisplaced fracture of the mid diaphysis of the femoral segment (Fig. 1 ). He was placed in a unilateral hip spica and kept non-weightbearing for four weeks Followup radiographs showed that union was progressing.
Development of pain in the thigh of a patient with proximal femoral focal deficiency who is normally ambulatory, may focus attention on potential complications of prosthetic use such as inadequate suspension, skin breakdown, or muscular strain secondary to an abnormal gait pattern. A previous episode of trauma may not be remembered at the time the patient presents for evaluation. The case demonstrates the fact that no matter how small the femoral segment, a fracture can occur and, accordingly, this must be considered in the differential diagnosis. In this patient, the fracture progressed to union without complication and we would advocate immobilization and interdiction of weightbearing, as in a normal child, until satisfactory healing has taken place.
Address correspondence to Dr. Beauchamp, 210-650 West 41st Avenue, Oakridge Centre, South Tower, Vancouver, British Columbia V5Z 2M9, Canada.
Aitken, G. T.: "PFFD-Definition, Classification and Management" in A Symposium on PFFD-A Congenital Anomaly. Washington, D.C: National Academy of Sciences, 1969.