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.

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.

Free vascularized fibular graft for treatment of pathological femoral neck fracture and osteonecrosis of the femoral head: A case report with a long-term follow-up

Microsurgery ◽  
2008 ◽  
Vol 29 (3) ◽  
pp. 240-243 ◽  
Author(s):  
Alexandros E. Beris ◽  
Marios G. Lykissas ◽  
Alexandros Payatakes ◽  
Vasileios A. Kontogeorgakos ◽  
Alexandros Mavrodontidis ◽  
...  
Keyword(s):  
Case Report ◽  
Femoral Head ◽  
Femoral Neck ◽  
Fibular Graft ◽  
Vascularized Fibular Graft ◽  
Long Term Follow Up ◽  
Neck Fracture ◽  
Free Vascularized Fibular Graft

scholarly journals Functional and Radiological Outcome of Unstable Intertrochanteric Fracture in Old Age Treated with Proximal Femoral Nail Antirotation-2

2021 ◽  
Author(s):  
OP Jamshad ◽  
Jacob Mathew ◽  
Raju Karuppal
Keyword(s):  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Biological Reduction ◽  
Neck Shaft Angle ◽  
Femoral Nail ◽  
Unstable Intertrochanteric Fracture ◽  
Shaft Angle ◽  
The Mean ◽  
Proximal Femoral Nail Antirotation

Introduction: Intertrochanteric fractures are prevalent in the elderly, which leave patients with functional restrictions. Proximal Femoral Nail Antirotation-2 (PFNA) was developed to achieve better fixation strength, particularly in the presence of osteoporotic unstable intertrochanteric fractures. Aim: To evaluate the role and result of PFNA-2 in the treatment of unstable intertrochanteric fractures in geriatric patients. Materials and Methods: A prospective analytical study was conducted in 35 patients with unstable intertrochanteric fractures. They were followed-up clinically and radiologically for one year. The quality of fixation was assessed, by neck-shaft angle and Tip Apex Distance (TAD). A functional assessment was done with the Harris Hip Score (HHS). Results: The mean follow-up period was 13 months (range, 12-14). The mean age of patients was 65.6 years and the majority were female patients (62.85%). Functional results according to modified HHS were found to be excellent in 6 (17.1%) patients, good in 14 (40%) patients, fair in 12 (34.3%) patients and poor in 3 (8.6%) patients. The average HHS in this study was 81.6. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 16.0. Conclusion: PFNA-2 helps in achieving biological reduction and good stability which enables early mobilisation and prevention of excessive collapse. A good functional outcome could be achieved when the radiological parameters are restored, i.e., TAD <25 mm and neck-shaft angle difference <5° (compared to the opposite side).

scholarly journals Valgus Osteotomy Outcome for Treating Femoral Neck Nonunion in Young and Active Patients

2021 ◽  
Vol 8 (2) ◽  
pp. 65-70
Author(s):  
Kaveh Gharanizadeh ◽  
◽  
Hamed Tayyebi ◽  
Abbas Esmaeli ◽  
Maziar Rajei ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Hip Arthroplasty ◽  
Limb Length Discrepancy ◽  
Osteotomy Site ◽  
Valgus Osteotomy ◽  
Neck Shaft Angle ◽  
Shaft Angle ◽  
The Mean

Background: Femoral neck fracture nonunion is a frequent and challenging complication, with several surgical options. Objectives: The present study reported the outcome of valgus osteotomy for treating femoral neck nonunion in patients aged <65 years. Methods: This case series research included young patients who underwent valgus osteotomy for treating femoral neck nonunion or device failure of the index surgery. The fixation of the osteotomy site was performed using either a dynamic hip screw or a fixed angle blade. The union of the neck and osteotomy site (subtrochanteric region) was evaluated by monitoring callus formation in the postoperative radiographs. Limb length discrepancy, Pauwels’ angle, and the neck-shaft angle were evaluated before the surgery and at the last follow-up. Postoperative complications were extracted from the explored patients’ profiles. Results: Twenty patients with a Mean±SD age of 27.2±10.8 years were examined in this study‎. The Mean±SD follow-up time of the patients was 6.1±3.9 years. The femoral neck was united in 18 patients in a Mean±SD period of 5.1±2.3 months. The Mean±SD limb length discrepancy was measured as 1.3±0.8 cm before and 0.5±0.7 cm after the ‏osteotomy. The Mean±SD Pauwels’ angle was calculated as 65.5±16.9º before and 32.4±16.2º after the osteotomy. The Mean±SD neck-shaft angle was computed to be 121.9±22.8º before and 144.5±17.7º after the osteotomy. Revision surgery was performed for 6 (30%) patients. This measure included device removal in 4 and total hip arthroplasty in 2 patient. Conclusion: Valgus osteotomy is a safe and efficient technique for managing femoral neck nonunion. Therefore‎, this approach is suggested as a good alternative for total hip arthroplasty, particularly in young and active patients‎.

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 Outcomes of Subcapital Femoral Fracture after a Fixation of an Intertrochanteric Fracture with a Proximal Femoral Nail: Case Report

2021 ◽  
pp. 56-61
Author(s):  
Jorge H. Nuñez ◽  
Jordi Teixidor ◽  
Felipe Borim ◽  
Vicente Molero ◽  
Jordi Tomas
Keyword(s):  
Case Report ◽  
Femoral Fracture ◽  
Intertrochanteric Fracture ◽  
Rare Complication ◽  
Femoral Fractures ◽  
Proximal Femoral Nail ◽  
Femoral Nail ◽  
Number Of Patients ◽  
Neck Fracture

Proximal femoral fractures are a common injury that represents an important cause of hospitalization, morbidity, and mortality in elderly patients. Subcapital femoral neck fracture after fixation of an intertrochanteric fracture with a proximal femoral nail is an extremely rare complication. However, because of the large and steadily increase in the number of patients undergoing to proximal femoral nail fixation in recent years, we believe that the number of these cases could increase over time. We present a 78-year-old woman with a subcapital femoral fracture 11 months after a fixation of intertrochanteric fracture with a proximal femoral nail in the same hip. Five years of follow-up was presented. Also through our case report a review of literature of these rare cases was done, trying to evaluate the associated risk factors, the difficulties in their treatment and the final follow-up of these patients.

scholarly journals Functional and radiological outcomes of intertrochanteric fractures treated with proximal femoral nail

2020 ◽  
Vol 6 (5) ◽  
pp. 1001
Author(s):  
Mayur Chopra ◽  
Sanjay Kumar Srivastava ◽  
Sumit Kumar ◽  
Deepak Kumar Mishra
Keyword(s):  
Weight Bearing ◽  
Proximal Femoral Nail ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Radiological Outcome ◽  
Neck Length ◽  
Neck Shaft Angle ◽  
Femoral Nail ◽  
Shaft Angle ◽  
Tip Apex Distance

<p><strong>Background:</strong> Hip fracture is one of the most invalidating diseases affecting geriatric populations and in fall related fractures, they lead to most severe morbidity and mortality. Their surgical treatment allows stable fracture fixation which allows the early weight bearing. Many devices have been developed, yet mechanical failures still occur. The aim of this study was to assess the functional and radiological outcomes of intertrochanteric fractures treated with proximal femoral nail.</p><p><strong>Methods:</strong> 46 patients with intertrochanteric fractures fixed with proximal femoral nail were assessed. Functional outcome was measured by Harris hip score (HHS) and lower extremity functional scale (LEFS) and radiological outcome was measured by tip apex distance (TAD), any changes in neck shaft angle, neck length and the offset as compared to uninjured hip.</p><p><strong>Results:</strong> The tip apex distance on the postoperative X-ray was found to be 22.02±2.499 mm, change in the neck length as compared to the uninjured hip was found to be 1.507±1.1808 and change in the offset and neck shaft angle was 1.470±1.0126 and -1.602±1.5992 respectively. The LEFS was found to be 70.63±6.584 whereas the HHS was found to be 90.35±7.593</p><p><strong>Conclusions:</strong> With the increase in TAD the functional and radiological outcome worsens. It was also seen that the cutoff of 25 mm stands true in predicting the outcome of the patients with PFN in intertrochanteric fractures. Hence, the TAD should be routinely measured and if found more than 25 mm then proper precautions like delayed weight bearing may be advised.</p>

Avoid to over-unlocking the helical blade in proximal femoral nail anti-rotation: a case report and literature review

2020 ◽  
Author(s):  
Wenchen Ji ◽  
Kai Liu ◽  
Meng Li
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Femoral Neck ◽  
Intertrochanteric Fracture ◽  
Lateral Wall ◽  
Treatment Method ◽  
Proximal Femoral Nail ◽  
Femoral Nail ◽  
Intraoperative Fluoroscopy ◽  
Helical Blade

Abstract Purpose To discuss the reason and treatment method of helical blade over-unlocking. Methods The case reported in this paper is that the helical blade cannot be locked due to over-unlocking during the treatment of intertrochanteric fracture with PFNA, which is very rare. We expound why it happens and how to deal with it. Results When the helical blade is over-unlocking, if the aiming arm is not disassembled, you can try to take out the helical blade and fix it again. If the aiming arm has been removed, it is not recommended to remove the helical blade, we suggest that we should consider adding a screw from the lateral wall through the femoral neck for anti-rotation, or you can observe the tail of helical blade and find suitable screw driver to fix it if there is one. Conclusions In order to avoid over-unlocking of the helical blade, intraoperative fluoroscopy should not only pay attention to the position of the helical blade, but also pay more attention to the abnormal shape of the helical blade itself. Once the helical blade is over-unlocking, it needs to be handled in time.

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.

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