Surgical Treatment of Femoral Pseudarthrosis in a Child With Significant Rotational Deformity: A Case Report

Pediatric femoral pseudarthrosis is rare, and particularly in cases with significant rotational deformity, insights regarding treatment guidelines and the safety of surgical techniques are limited. In this report, we present a case of pediatric femoral pseudarthrosis that achieved good bone union and functional recovery through one-stage rotational correction combined with a wake-up test to avoid neurological complications. A 12-year-old boy, who had undergone surgical fixation for a right diaphyseal femur fracture at a previous hospital, was diagnosed with pseudarthrosis with 56° of external rotation deformity. At our institution, after freshening the pseudarthrosis site, we performed a one-stage rotational correction of 56° using a Hoffman-type external fixator while evaluating the nerve injury with a wake-up test. Neither intraoperative nor postoperative nerve impairment was observed, and synostosis was achieved at 13 postoperative weeks. In the correction of rotational deformities, particularly in cases with large correction angles, there is a risk of nerve damage due to traction or compression of peripheral nerves. The wake-up test is a simple method for directly assessing nerve function, even under conditions with limitations on monitoring equipment, and it is useful for the early detection and prevention of neurological complications. In this case, a 56° rotational correction for pediatric femoral pseudarthrosis was performed in a one-stage procedure, and safe surgery was accomplished through intraoperative neurological assessment using the wake-up test. This suggests that the wake-up test can be a valuable auxiliary evaluation method even in situations where intraoperative nerve monitoring is limited.