Etiology of the bifid (double) femoral head, with prior history of developmental dysplasia of the hip

Leonard P. Seimon, Christine Kohler-Ekstrand, Howard D. Dorfman

Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, USA;.

DOI: 10.4236/crcm.2013.25085                

Abstract

Our patient presented with a double femoral head, that is, two separate heads with individual epiphyses, but a single contiguous metaphysis. Two similar cases had been described in the literature. The only common feature in these three cases is that they had open reduction for Developmental Dysplasia of the Hip (DDH) through an anterior approach. No other pathology was detected in these patients. A rabbit model was created in which the cartilaginous anlage of the rabbit femoral head was surgically split. After 2-4 weeks a bifid femoral head developed, mimicking that described in the literature. We suggest that inadvertent damage to the femoral head during surgery for DDH may in fact lead to the development of a bifid femoral head. Prior history of DDH should be considered when the isolated bifid femoral head is identified.

Keywords

Bifid; Femoral Head; Etiology; Rabbit Study

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Ferguson, A. (1981) Orthopaedic surgery in infancy and childhood. 5th Edition, Williams and Wilkins, Baltimore, 292-294.
[2]	Rossman, M. and Jequier, S. (1982) The double-headed femur. Clinical Orthopaedics and Related Research, 162, 170-172.
[3]	Salter, R., Kostuik, J. and Dallas, S. (1969) Avascular necrosis of the femoral head as a complication of the dislocation of the hip in young children. A clinical and experimental investigation. Canadian Journal of Surgery, 12, 44.
[4]	Rudicel, S., Lee, K. and Pelker, R. (1985) Dimensions of the rabbit femur during growth. American Journal of Veterinary Research, 46, 289-299.
[5]	Heikel, H. (1960) On ossification and growth of certain bones of the rabbit; with a comparison of the skeletal age in the rabbit and in man. Acta Orthopaedica Scandinavica, 39, 171-185.
[6]	Osuji, C.K., Chafik, D. and Moseley, C.F. (2009) Unilateral proximal bifurcation of the femur. Journal of Pediatric Orthopaedics, 29, 695-697. doi:10.1097/BPO.0b013e3181b76985