Two-Stage Surgical Treatment of Complex Femoral Deformities with Severe Coxa Vara in Polyostotic Fibrous Dysplasia.

Abstract

For complex femoral deformities in patients affected by polyostotic fibrous dysplasia and coxa vara associated with shepherd's crook deformity of the femoral shaft, the correct treatment is stabilization with an interlocking cervicodiaphyseal nail after correction of all of the femoral deformities. Evaluate the patient radiographically and select the hardware. Position the patient on the traction table. Expose the lateral aspect of the proximal part of the femur and mark the position of both the blade-plate and the osteotomy. Prepare the slot for the blade, perform the osteotomy, and correct the valgus alignment of the proximal part of the femur. Check postoperative bleeding, provide blood transfusions if needed, and have the patient resume walking. Study the patient radiographically, simulate the osteotomies, perform another assessment of lower-limb length, and select the hardware. Position the patient on the traction table and expose the lateral aspect of the femur from the tip of the greater trochanter to the level of the most distal planned osteotomy. All of the osteotomies are performed, and a medullary canal is drilled in each femoral fragment. Introduce the nail into the osteotomy fragments and insert the spiral blade and distal locking screws. Check postoperative bleeding, which is usually marked; administer blood transfusions as needed; and have the patient resume walking. We performed this surgery on 13 femora in 11 patients.