Trapdoor Procedure for Benign Bone Lesions in the Femoral Head of Skeletally Immature Children

Abstract

Objective: Benign bone lesions involving the femoral head are common in pediatric populations but pose significant challenges due to anatomical complexity and the need to preserve growth plate integrity. This study aims to evaluate the efficacy of the trapdoor procedure in treating these lesions in skeletally immature patients.

Methods: From 2013 to 2023, five pediatric patients with femoral head bone lesions were identified who underwent the trapdoor procedure retrospectively. Preoperative assessments included computed tomography (CT) and magnetic resonance imaging (MRI). Follow-up spanned a mean of 37.8 ± 11.2 months, with attention to pathology, recurrence, and complications. Functional outcomes were assessed using the McKay clinical grading method.

Results: Histological examination postoperatively confirmed Langerhans cell histiocytosis (LCH) in two patients and chondroblastoma in two others. One patient's diagnosis remained unclear, indicating only fibrous tissue cell proliferation. No recurrences were observed, but avascular necrosis (AVN) occurred in both LCH patients, necessitating revision surgery.

Conclusions: The trapdoor procedure is a safe and effective method for treating benign bone lesions of the femoral head in children, with attention needed for the potential of AVN.

Keywords

children / chondroblastoma / femoral head / LCH / trapdoor procedure

References

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2025 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.