Rotational valgus osteotomy for shepherd’s crook deformity: a case report

Abstract

Fibrous dysplasia (FD) is a benign medullary fibro-osseous lesion that may present as monostotic or polyostotic. Bone deformities often manifest in polyostotic FD, especially in the femoral neck region, due to repeated microfractures. The deformity observed in the proximal femur has been referred to as shepherd’s crook deformity and is characterized by coxa vara. This deformity causes shortening of the affected limb, limited range of motion (ROM) of the hip joint, and a reduction in the gluteus medius muscle, resulting in the marked aggravation of function in the affected limb [1, 2]. Surgical treatment for FD should be performed when a pathological fracture occurs or serious symptoms develop due to the deformity; however, correcting shepherd’s crook deformity to obtain a desirable mechanical axis and lengthening the lower limb is challenging [2–6]. Furthermore, weight bearing is restricted for a long period until both treated femora obtain sufficient bony union. We report a case of a patient with bilateral shepherd’s crook deformity associated with FD treated with a newly formulated surgical method: rotational valgus osteotomy and intramedullary nailing.