scholarly journals Simultaneous Morscher’s osteotomy and arthroscopic debridement in the management of Legg–Calvé–Perthes disease: a case report and literature review

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. i4-i8
Author(s):  
Batool Bosakhar ◽  
Hassan Baldawi ◽  
Kathy Liu ◽  
Olufemi R Ayeni ◽  
Waleed Kishta
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Femoral Neck ◽  
Perthes Disease ◽  
Labral Repair ◽  
Coxa Vara ◽  
Neck Shaft Angle ◽  
Shaft Angle ◽  
Outcome Tool

Abstract There is a lack of consensus around optimal surgical management for Legg–Calvé–Perthes Disease (LCPD). This case report discusses the benefits of combining arthroscopic femoral neck osteochondroplasty and labral repair with Morscher’s Osteotomy (MO) for LCPD. S.A. is a 17-year-old female diagnosed with LCPD at the age of 6 years and has long-standing right hip symptoms. An arthroscopic femoral neck osteochondroplasty and labral repair followed by MO was performed. The pre-operative and 8 months post-operative International Hip Outcome Tool (iHOT-12) scores were 16.3 and 79.8 out of 100, respectively, indicating better quality-of-life. Also, the femoral neck-shaft-angle (NSA) changed from 120 pre-operative to 138.7 post-operative to represent the correction of coxa vara. The literature review revealed no published reports describing combined MO with hip arthroscopic interventions in managing LCPD. Combined arthroscopic femoral neck osteochondroplasty (with labral repair) and MO provides high patient satisfaction and improves radiographic parameters in patients with LCPD.

Nonunion Paediatric Femoral Neck Fracture Treatment without Open Reduction

2016 ◽  
Vol 26 (6) ◽  
pp. 608-611 ◽  
Author(s):  
Perajit Eamsobhana ◽  
Kamolporn Keawpornsawan
Keyword(s):  
Femoral Neck ◽  
Open Reduction ◽  
Harris Hip Score ◽  
Coxa Vara ◽  
Fracture Treatment ◽  
X Ray ◽  
Neck Shaft Angle ◽  
Nonunion Site ◽  
Neck Fracture ◽  
Shaft Angle

Objectives Fractures of the proximal femur account for less than 1% of all children's fractures. Because of this, most orthopaedic surgeons lack enough experience in treating them. This adds to the rather high incidence of complications especially nonunion. At the time of this review there is no consensus on which method of treatment of the nonunion is the best. The objective of this study is to present our method of treatment to correct the nonunion without open reduction of the nonunion sites. Method 9 children with nonunion of the proximal femur with an average age of 10.2 years (2-14 years old) were included in the study. There were 7 males and 2 females. All of them underwent at least 1 operation to treat the initial fractures and the nonunion. The nonunion in all these 9 cases was treated with valgus intertrochanteric osteotomy without open reduction of the nonunion site. The healing time of the nonunion, the postoperative neck-shaft angle and the functional outcome were evaluated. Results All the nonunion cases had coxa vara and had bone resorption of the femoral neck with x-ray evidences of avascular necrosis (AVN). Ratliff classification was used to classify the AVN, Ratliff type 3 was found in 4 cases, Ratliff 2 in 1 case and Ratliff 1 in 4 cases. Patients were followed for an average of 68 (range 36-156) months. All patients had x-ray evidence of solid union of the nonunion in an average time of 15.4 (range 13-18) weeks and union of the osteotomy sites within10.6 (range 9-12) weeks. The postoperative neck-shaft angle averaged 135° (range 125°-150°) compared to 98° before the surgery. The increase in the amount of neck-shaft angle was statistically significant (p<0.001). Using Harris Hip Score, 2 patients were graded as excellent, 3 patients were graded as good and 4 patients were graded as fair. Harris Hip Score was significantly improved compared to the preoperative status (p<0.001). Conclusions Nonunion paediatric femoral neck fracture treatment could be successfully treated without open reduction by using valgus intertrochanteric osteotomy. All patients obtained union of the nonunion site and the osteotomy site in this study. Harris Hip Score showed significant improvement. This technique can be used to treat nonunion with associated coxa vara, bone resorption and AVN with satisfactory results even in cases who had received several operations before.

scholarly journals Double Intertrochanteric Osteotomy for Trochanteric Overgrowth and a Short Femoral Neck in Adolescents

2016 ◽  
Vol 24 (3) ◽  
pp. 387-391 ◽  
Author(s):  
Turgut Akgul ◽  
Cengiz Şen ◽  
Halil Ibrahim Balci ◽  
Gokhan Polat
Keyword(s):  
Femoral Neck ◽  
Delayed Union ◽  
Developmental Dysplasia ◽  
Intertrochanteric Osteotomy ◽  
Coxa Vara ◽  
Neck Shaft Angle ◽  
Shaft Angle ◽  
Proximal Femoral Focal Deficiency ◽  
Femoral Side

Purpose To review the outcome of Wagner double intertrochanteric osteotomy for trochanteric overgrowth and a short femoral neck in 7 adolescents. Methods Records of one male and 6 females aged 15 to 20 years who underwent modified Wagner osteotomy for trochanteric overgrowth and a short femoral neck by a single senior surgeon were reviewed. The diagnoses were coxa vara (n=2), developmental dysplasia of the hip (n=3), Leg-Calve-Perthes (n=1), and proximal femoral focal deficiency (n=1). Radiological indication for double intertrochanteric osteotomy included a neck-shaft angle (NSA) <120° or a centre trochanter distance (CTD) <28 mm. Function was evaluated using the Children's Hospital Oakland Hip Evaluation Scale (CHOHES). The articulotrochanteric distance (ATD), CTD, NSA, and the distance between the centre of the femoral head and the centre of the acetabulum (MZ) were measured on radiographs. Results The mean follow-up duration was 61 (range, 28–86) months. The ATD improved from 16±11.5 mm to −6.3±10.2 mm (p=0.018), the CTD from 27.9±3.5 mm to 36.4±7.1 mm (p=0.018), the NSA from 112°±24.4° to 131°±16° (p=0.028), the MZ from 12.7±6.5 mm to 7.7±4.2 mm (p=0.028), and the CHOHES score from 62.1±8.7 to 84±9.6 (p=0.017). One patient had delayed union. Two patients had persistent Trendelenburg gait. Two patients declined second-stage surgery for acetabular dysplasia after solving the femoral side problems at the first stage. One of them developed hip arthrosis. Conclusion Double intertrochanteric osteotomy is a viable treatment option for adolescents with trochanteric overgrowth and a short femoral neck.

scholarly journals One-Stage Osteotomy and Fixation Using a Long Proximal Femoral Nail and Fibular Graft to Correct a Severe Shepherd's Crook Deformity in a Patient with Fibrous Dysplasia: A Case Report

2009 ◽  
Vol 17 (2) ◽  
pp. 245-247 ◽  
Author(s):  
Himanshu Kataria ◽  
Neeraj Sharma ◽  
Rajesh Kumar Kanojia
Keyword(s):  
Case Report ◽  
Femoral Neck ◽  
Fibrous Dysplasia ◽  
Proximal Femoral Nail ◽  
Fibular Graft ◽  
Neck Shaft Angle ◽  
One Stage ◽  
Femoral Nail ◽  
Shaft Angle

We report a case where a one-stage osteotomy and fixation, using a long proximal femoral nail and fibular graft, was performed to correct a severe shepherd's crook deformity (70° varus and 50° retroversion) of the femoral neck with a pathological stress fracture in a patient with fibrous dysplasia. The neck shaft angle was corrected to 125°. At the 57-month follow-up, the patient was free of pain and had no limp or evidence of recurrence.

Alterations in Stresses due to Various Femoral Deformities Across the Hip Joint: FEA Analysis

2008 ◽  
Author(s):  
Mitul Y. Vyas ◽  
Sanjeev Sabharwal ◽  
Noshir A. Langrana
Keyword(s):  
Proximal Femur ◽  
Slipped Capital Femoral Epiphysis ◽  
Indirect Costs ◽  
Poor Quality ◽  
Coxa Vara ◽  
Neck Shaft Angle ◽  
Abnormal Gait ◽  
Shaft Angle ◽  
Fea Analysis

The manifestation of osteoarthrosis by an abnormality such as hip dysplasia, slipped capital femoral epiphysis (SCFE), coxa vara and Legg-Calve-Perthes disease is one of the leading causes of chronic orthopaedic disability, resulting in billions of dollars in treatment and indirect costs, such as lost wages for the patient [1]. Additionally, these conditions are severely painful, inducing a reduction in range of motion, abnormal gait and consequently, poor quality of life. In patients with SCFE, the proximal femur collapses as a result of epiphyseal displacement, resulting in femoroacetabular impingement and acetabular erosion [1, 2]. Patients with developmental coxa vara (DCV), a pediatric hip disorder, exhibit triplanar deformity of the proximal femur. The abnormal neck–shaft angle and associated change in the articulo-trochanteric distance (ATD) alter the biomechanics of the hip adversely, and is often accompanied by limb length discrepancies [3].

The association between femoral neck shaft angle and degenerative disease of the hip in a cadaveric model

2021 ◽  
pp. 112070002110130
Author(s):  
Leigh-Anne Tu ◽  
Douglas S Weinberg ◽  
Raymond W Liu
Keyword(s):  
Femoral Head ◽  
Femoral Neck ◽  
Hip Osteoarthritis ◽  
Volume Ratio ◽  
Femoral Head Coverage ◽  
Neck Shaft Angle ◽  
Hip Arthritis ◽  
Femoral Version ◽  
Shaft Angle ◽  
The Impact

Background: While the influences of acetabular dysplasia and overcoverage on hip arthritis have been studied, the impact of femoral neck-shaft angle on hip arthritis is much more poorly understood. The purpose of this study is to determine if a relationship exists between neck shaft angle and the development of osteoarthritis, a better understanding of which would be useful to surgeons planning osteotomies about the hip. Methods: 533 cadaveric femora and acetabulae (1066 total) from the Hamann-Todd Osteological Collection (Cleveland, OH) were acquired. We measured true neck shaft angle using an AP photograph with the femoral neck parallel to the table. Femoral head volume to acetabular volume ratio, representing femoral head coverage, as well as femoral version were utilised. Correlation between neck shaft angle, femoral version, femoral head coverage and osteoarthritis were evaluated with multiple regression analysis. Results: The mean age and standard deviation was 56 ± 10 years. There were 64 females (12%) and 469 males. There were 380 Caucasians (71%) and 153 African-Americans. Mean femoral version was 11° ± 12° and mean true neck shaft angle was 127.7° ± 5.9° There was a strong correlation between age and arthritis (standardised beta 0.488, p < 0.001). There was a significant correlation between increasing true neck shaft angle and decreasing hip arthritis (standardised beta -0.024, p = 0.038). In the femoral head overcoverage subset, increasing true neck shaft angle was still significantly associated with decreasing hip arthritis (standardised beta −0.088, p = 0.018), although this relationship was not significant with femoral head undercoverage subset. Conclusions: With sufficient acetabular coverage, a relative increase in femoral neck shaft angle within the physiologic range is associated with decreased hip osteoarthritis. Clinical relevance: An understanding of the relationship between femoral neck shaft angle and hip osteoarthritis could be useful for surgeons planning pelvic or proximal femur osteotomies in children.

scholarly journals Sexual Variations of Femoral Neck-Shaft Angle in the Population of Odisha

2021 ◽  
Vol 10 (19) ◽  
pp. 1387-1390
Author(s):  
Rajeev Kumar Kanchan ◽  
Sonali Subhadarsini ◽  
Dharma Niranjan Mishra ◽  
Chinmayi Mohapatra
Keyword(s):  
Femoral Neck ◽  
Ventral Surface ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Legal Cases ◽  
Male And Female ◽  
Neck Shaft Angle ◽  
Femur Neck ◽  
Shaft Angle ◽  
The Right

BACKGROUND The peculiar waddling gait of a female attracts most of the anatomists to measure and compare the neck-shaft angle (NSA) of the femora. The femoral neck shaft angle is greater in women due to greater pelvic breadth and shorter femur. Neck-shaft angle was measured by the angle that the neck makes with the shaft of the femur and it is measured on the ventral surface of femur taking the long axis of femoral neck with the long axis of the proximal end of the femur. It gives information about the race it belongs to and normally measures 120° to 140°. The intention of this study was to establish the femoral neck shaft angle variations in adult male and female for medico-legal and anthropometric studies. METHODS This cross-sectional study was conducted on 84 adult human femora of unknown sex in the anatomy department, Sriram Chandra Bhanja (SCB) Medical College, Cuttack, Odisha, from May 2018 to April 2019. We included all the femora which were free of damage or deformity and fully ossified indicating adult bone. Femora with any pathological changes i.e., cortical bone deterioration, extreme osteophyte activity, osteoarthritis and fracture etc. were excluded from the study. The NSA was measured by protractor and goniometer. RESULTS In the present study the NSA range for the right femur of male was 108° - 135° and for the right femur of females 117° - 135°. The left male femur was 118° - 135° and the left female femur was 120° - 135°. The mean neck shaft angle of male femora was 125.9° and the female femora was 125.7°. These measurements show that the values were more in males than the females. The value of the present study was statistically significant between male and female i.e., P < 0.0001. CONCLUSIONS These measurements are important in the medico-legal cases, reconstructive orthopaedic surgeries, hip replacement surgeries and also while constructing suitable prosthesis. This will also be helpful in the detection of sex by anatomists and forensic experts. KEY WORDS Neck Shaft Angle, Medico-Legal, Anthropometry and Goniometer

Morphometric Study of Femoral Neck-Shaft Angle in Kolar Population and Its Clinical Importance

2019 ◽  
Vol 8 (3) ◽  
pp. 226-232
Author(s):  
Suresh NM ◽  
◽  
Sunitha R ◽  
Aruna N ◽  
Nalini JP ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Clinical Importance ◽  
Morphometric Study ◽  
Neck Shaft Angle ◽  
Shaft Angle

The Association Between Femoral Neck-Shaft Angle and Aging and Its Influence on the Performance of Functional Activity: A Cross-Sectional Investigation

2020 ◽  
Vol 28 (2) ◽  
pp. 250-254
Author(s):  
Ibrahim M. Altubasi
Keyword(s):  
Femoral Neck ◽  
Regression Models ◽  
Walking Speed ◽  
Functional Performance ◽  
Hierarchical Regression ◽  
Performance Tests ◽  
Cross Sectional ◽  
Neck Shaft Angle ◽  
Functional Activities ◽  
Shaft Angle

The purposes of this study were first to examine the association between aging and both the magnitude and asymmetry in the femoral neck-shaft angle (NSA). The second purpose was to determine the effects of both the magnitude and NSA asymmetry on the performance of functional activities in healthy individuals. Fifty-one subjects participated in this study. The femoral NSA was measured on computed tomography scout images. The participants performed four performance tests. Four hierarchical regression models were constructed to explore the effect of each predictor on the outcomes. Aging was associated with NSA asymmetry, but not with the degree of NSA. Age contributed significantly to the variability of all functional performance tests except the 10-m walking speed. The degree of the NSA did not contribute to the prediction of the functional performance tests. However, asymmetry in the NSA added significantly to the prediction of all functional performance tests except the 10-m walking speed.

scholarly journals Femoral neck-shaft angle in humans: variation relating to climate, clothing, lifestyle, sex, age and side

2013 ◽  
Vol 223 (2) ◽  
pp. 133-151 ◽  
Author(s):  
Ian Gilligan ◽  
Supichya Chandraphak ◽  
Pasuk Mahakkanukrauh
Keyword(s):  
Femoral Neck ◽  
Neck Shaft Angle ◽  
Shaft Angle
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