Valgus osteotomy combined with intramedullary nail for Shepherd’s crook deformity in fibrous dysplasia: 14 femurs with a minimum of 4 years follow-up

Abstract

To investigate the effectiveness of valgus osteotomy combined with intramedullary nail in treatment of Shepherd's crook deformity of fibrous dysplasia. A retrospective study was performed in 13 patients (14 femora) of fibrous dysplasia who were treated in our hospital between August 2000 and February 2005. All patients had Shepherd's crook deformity. Six patients had monostotic disease, and seven had polyostotic disease. There were seven males and six females. The four-step procedure was performed orderly as valgus osteotomy, curettage lesion, massive impaction allograft, and insert intramedullary nail with neck cross pinning. All patients were followed up from 4 to 7 years with an average duration of 75.3 months. The average neck-shaft angle was corrected from preoperative 75 degrees (range 55 degrees -100 degrees ) to postoperative 120 degrees (range 95 degrees -130 degrees ). The average extremity lengthening was 3.4 cm (range 2.0-4.5 cm). 19 location of osteotomy showed good union. There were no infection and recurrent fracture and progression of deformity. The valgus osteotomy can correct Shepherd's crook deformity, prevent recurrent fracture, and restore alignment, thus improve functioning of limb. The intramedullary nail with neck cross pinning should be the first consideration of internal fixation. Massive impaction allograft is the key technique to improve full incorporation of allograft and to prevent pathological fracture.