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Osteonecrosis Following Isolated Avulsion Fracture of the Greater Trochanter in Children A Report of Two Cases
Michael R. O'Rourke, MD; Stuart L. Weinstein, MD
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Investigation performed at the Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa

Michael R. O'Rourke, MD
Stuart L. Weinstein, MD
Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242. E-mail address for S.L. Weinstein: stuart-weinstein@uiowa.edu

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

J Bone Joint Surg Am, 2003 Oct 01;85(10):2000-2005
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Isolated avulsion fracture of the greater trochanter is a rare condition in both adults and children 1-3 . Injury to the proximal part of the growing femur has been associated with osteonecrosis of the epiphysis and metaphysis, particularly with epiphyseal separation and fracture of the femoral neck 4-6 . The blood supply to the proximal femoral epiphysis has been well described by Trueta 7 , Chung 8 , and Ogden 9 . Injury to the vulnerable posterolateral branches of the medial femoral circumflex artery has been implicated in the development of necrosis as a result of direct trauma, compression from an intracapsular hematoma, and iatrogenic injury during treatment 4-6,10-13 . Kaweblum et al. 11 reported the case of a twelve-year-old child in whom treatment of an isolated avulsion fracture of the trochanter with open reduction and internal fixation resulted in osteonecrosis of the femoral epiphysis.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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