Valgus osteotomy in combination with dynamic hip screw fixation for fibrous dysplasia with shepherd’s crook deformity

Abstract

The treatment of fibrous dysplasia with shepherd's crook deformity is a big challenge. The purpose of this study was to investigate the clinical effect of valgus osteotomy in combination with dynamic hip screw (DHS) fixation to treat fibrous dysplasia with shepherd's crook deformity. Twenty-one clinical cases of femoral fibrous dysplasia with shepherd's crook deformity treated between April 2001 and May 2010 were retrospectively analyzed. The valgus osteotomy and internal fixation were performed for these patients. Six patients underwent DHS and trochanter stabilizing plate internal fixation, and the other 15 cases were stabilized by DHS fixation. Patients were followed for 19-128 months. The neck-shaft angle was corrected from 89° (range 65°-107°) preoperatively to 129° (range 119°-140°) postoperatively. Limb-length discrepancy was corrected from 3.0 (range 1.8-4.5) cm preoperatively to 0.7 (range 0-1.9) cm postoperatively. All osteotomies had healed at the final follow-up examination. The clinical scores, which were evaluated by the modified criteria of Guille, improved from an average of 2.9 (range 1-7) to 8.5 (range 6-10). Our results demonstrate that valgus osteotomy in combination with DHS internal fixation is an easy and effective method for the treatment of fibrous dysplasia with shepherd's crook deformity. It can restore the neck-shaft angle and re-establish the mechanical alignment of the femur to improve function.