Valgus Intertrochanteric Osteotomy Research Articles

Valgus intertrochanteric osteotomy for malunion and nonunion of trochanteric fractures.

To evaluate the results of valgus intertrochanteric osteotomy for varus nonunion and malunion of trochanteric fractures. University hospital. Retrospective clinical study. Fifteen patients (age range 29-84 years) with varus malunion (11 cases) or varus nonunion (4 cases). Indication for surgery was nonunion or varus malunion with limb shortening greater than 2 cm associated with limp, abductor muscle insufficiency, hip pain, and back pain. The patients were treated by a valgus intertrochanteric osteotomy fixed with a 120 degrees double-angled blade plate. Average follow-up was 5.5 years (range 2-10 years). Fourteen patients healed without complications: 12 patients within 4 months; 2 delayed unions within 6 months. One patient required revision surgery for a loss of fixation due to a fall 6 weeks after surgery. This osteotomy also healed. Average lengthening achieved by osteotomy was 2 cm (range 1-5 cm). In all patients, the resulting range of flexion in the hip joint was greater than 90 degrees, Harris hip score before surgery was 73 points (range 61-83), and after surgery 92 points (range 76-98). Osteoarthritis or avascular necrosis of the femoral head did not develop in any of the cases. Valgus intertrochanteric osteotomy is an effective procedure that reliably restores hip function in trochanteric malunion or nonunion.

Ipsilateral femoral neck and shaft fractures: complications and their treatment.

An ipsilateral femoral neck fracture occurs in approximately 6% to 9% of all femoral shaft fractures. Despite this relatively common presentation, decision-making often is difficult. Furthermore, the risk for complications is greater in the treatment of this combination injury pattern than for single-level fractures. A retrospective review of the authors' large trauma database revealed 13 patients who had healing complications develop after their index surgical procedure. Six of the eight (75%) femoral neck nonunions occurring in these 13 patients developed after the use of a second generation, reconstruction-type intramedullary nail. Factors contributing to nonunion of the femoral shaft were the presence of an open fracture, use of an unreamed, small diameter intramedullary nail, and prolonged delay to weightbearing. The femoral neck nonunions healed after either valgus intertrochanteric osteotomy (seven patients) or compression hip screw fixation (one patient). The femoral shaft nonunion proved more difficult than expected to treat with some patients with femoral shaft nonunions requiring more than one operative procedure to achieve union. Lag screw fixation of the femoral neck fracture and reamed intramedullary nailing for shaft fracture stabilization were associated with the fewest complications. Therefore, this approach is recommended as the treatment of choice.

ECCENTRIC ROTATIONAL ACETABULAR OSTEOTOMY FOR ACETABULAR DYSPLASIA

Eccentric rotational acetabular osteotomy for the operative treatment of acetabular dysplasia consists of a spherical but eccentric osteotomy and rotation of the acetabulum that moves the center of rotation of the head of the femur medially and distally. No bone graft is needed. The reorientation of the acetabular fragment not only improves acetabular coverage but also restores the center of rotation of the subluxated hip. The purpose of this paper was to describe eccentric rotational acetabular osteotomy for the treatment of acetabular dysplasia and to evaluate its clinical and radiographic outcomes. We performed this procedure consecutively in 132 hips in 126 patients with dysplasia of the hip. Eighteen hips had no osteoarthritis, fifty-three had early osteoarthritis, and sixty-one had advanced osteoarthritis. Seven patients were male, and 119 were female. The average age was 36.5 years at the time of the index operation, and the average duration of follow-up was 7.5 years. Twenty-three hips in twenty-two patients were also treated with intertrochanteric valgus osteotomy to further improve joint congruency at the time of the acetabular osteotomy. The average preoperative Harris hip score of 71 points improved to an average score of 89 points at the time of the latest follow-up. The average center-edge angle improved from 0 to 36 . An apparent change in the stage of the arthritis was observed in seven hips (5%), one of which had had early-stage disease and six of which had had advanced disease preoperatively. Eccentric rotational acetabular osteotomy appears to be a good treatment option for young patients with either early or advanced hip osteoarthritis secondary to dysplasia.

Coxa Vara: Another Option for Fixation

Coxa vara is a progressive childhood deformity that is best remedied by a valgus intertrochanteric osteotomy. By restoring the femoral neck and its physis to a more anatomic position, hip mechanics are normalized, with consequent beneficial effects upon hip motion, limb lengths and acetabular development. In the pediatric age group, there is no implant specifically designed for this purpose. Therefore, in addition to the challenge of obtaining adequate correction, inadequate fixation may contribute to recurrent varus deformity, a problem that, according to the literature, has a 30% to 70% prevalence. We are presenting a new technique using a modified veterinary plate for osteosynthesis in children in the 5-year-old to 11-year-old age group. The rationale, implant design, surgical technique and results in a group of nine patients (12 hips) are described.

Valgus intertrochanteric osteotomy for neglected femoral neck fractures in young adults.

Twenty cases of neglected (more than 1 month old) displaced femoral neck fractures in young adults were treated with a valgus intertrochanteric osteotomy. A fracture union rate of 85% (17 cases) was achieved. Two of the healed cases developed avascular necrosis. After 30 months 15 patients (75%) had achieved good to excellent results. We believe that intertrochanteric osteotomy provides good alternative management for neglected femoral neck fractures.

変形性股関節症に対する大腿骨転子間外反骨切り術（杉岡）の術後成績

Valgus intertrochanteric osteotomy is an effective treatment for osteoarthritis of the hip in younger patients. However, the disadvantage of this osteotomy is the difficult stem insertion at the time of subsequent total hip arthroplasty. Sugioka designed transtrochanteric valgus osteotomy to overcome this disadvantage. The purpose of the present study was to report the short-term results after operateion. The results of the first 10 hips in patients were prospectively studied with a minimum of 6-months follow-up. All patients had a long history of hip pain. The average age at the time of operation was 45.7 years. All patients had a flexion arc of at least 80 degrees and at least 20 degrees of passive adducion. Preoperative radiographs of the patients showed an elliptical deformity of the femoral head associated with a well-developed infermedial osteophyte and improved congruence of the articular surfaces was demonstrated in full adduction. Operatve corrections averaged 19 degrees of valgus and 6 degrees of extension. Bone union of both the femoral and trochanteric osteotomies was obtained in all hips. Hip pain was relieved in all except one hip.

Intertrochanteric Osteotomy for Failed Internal Fixation of Femoral Neck Fracture

Thirteen patients with failed internal fixation of the femoral neck were treated with valgus intertrochanteric osteotomy performed by one surgeon from 1987 to 1995. The patients ranged in age from 18 to 59 years. The interval from injury to osteotomy ranged from 4 to 54 weeks. With an average followup of 25 months (range, 9-42 months), the femoral neck fracture healed in all patients. Twelve patients returned to being fully weightbearing without pain. The average limb shortening was improved by 1 cm. Seven of eight patients who were employed before their injuries returned to the same occupations. Femoral head collapse because of avascular necrosis developed in one patient 18 months after surgery and return to full activities and in a second patient shortly after the osteotomy. These two patients now have an arthroplasty. The remainder of the patients have done well without requiring additional surgery. Harris hip scores and Short Form 36 Health Status Survey outcome scoring were available to verify the results in 10 patients.

Hüfteahe operative eingriffe — ein mechanisches problem

From the analysis of a case report the author draws the following conclusions: Combining a perfect reduction with a valgus intertrochanteric osteotomy and a stable fixation ensures almost certainly against non union and probably against a high rate of avascular necrosis in cases of subcapital fractures of the neck of the femur. However, increased compressive stresses must be expected in the joint, above all in obese patients or if the joint surfaces are not congruent. Therefore, unloading is recommended and a secondary varus intertrochanteric osteotomy should be carried out as soon as bony union is achieved. Pauwels' intertrochanteric osteotomy constitutes a sensible treatment of osteoarthritis of the hip and gives amazingly long term good results if the weight bearing surfaces of the joint can be increased and the articular pressure is thus considerably reduced. The cyst in the femoral head results from fractures of cancellous trabeculae subjected to stresses which are beyond of functional adaptation.

New plate for lateral translation in valgus intertrochanteric osteotomy (CUN plate).

A new plate is presented for internal fixation of valgus intertrochanteric osteotomy. This plate enables a controlled translation, permits dynamic compression of the osteotomy line and eludes some of the complications involved in the use of other double-angle plates. The morphological characteristics of the plate as well as its technical and surgical aspects are described. A follow-up study of 63 patients operated on between January 1978 and June 1980 has been carried out, underlining some of the mistakes that can affect the healing time.