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Type I Transepiphyseal Separation

- Discussion:
    - least common pediatric femoral neck frx (about 7%);
    - capital femoral epiphysis may stay w/in acetabulum but in 50% of cases the capital fragment is dislocated;
    - tends to occur in infants and young children;
    - this injury may be the result of a difficult delivery;
          - look for pseudoparalysis as well as shorteing, flexion, and external rotation of the extremity;
          - ultrasound may help make the diagnosis;
          - diff dx includes a septic hip;
    - w/ this injury, blood vessels to femoral head are usually damaged, there is & a high incidence of avascular necrosis (upto 100 %)
    - growth arrest in epiphysis can cause shortening of upto 15% (see growth deformities);
    - valgus or varus angulation of femoral neck can occur from arrest of only one side of the epiphyseal plate;

- Treatment:
    - indications for preoperative hip aspiration (or intra-operative capsulotomy) remain unclear;
    - young children:
         - smooth pins are inserted across the epiphysis in most cases;
         - problem: smooth pins do not back out with collapse at frx site (as do threaded pins) and may penetrate into acetabulum;
         - thread pins may damage physis and cause partial growth arrest, and therefore are usually avoided;
         - one solution is to use pins which are smooth at the tips but are threaded in the midshaft;
    - adolescents:
         - cannulated screws

Transepiphyseal fractures of the neck of the femur in very young children.

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