Skip to main content
SpringerLink
Log in

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

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background and objectives

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.

Method

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.

Results

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).

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Harris WH, Dudley HR Jr, Barry RJ (1962) The natural history of fibrous dysplasia. An orthopaedic, pathological, and roentgenographic study. J Bone Joint Surg Am 44:207–233

    PubMed  Google Scholar 

  2. Stompro BE, Wolf P, Haghighi P (1989) Fibrous dysplasia of bone. Am Fam Physician 39:179–184

    PubMed  CAS  Google Scholar 

  3. Funk FJ Jr, Wells RE (1973) Hip problems in fibrous dysplasia. Clin Orthop Relat Res 90:77–82

    PubMed  Google Scholar 

  4. Grabias SL, Campbell CJ (1977) Fibrous dysplasia. Orthop Clin North Am 8:771–783

    PubMed  CAS  Google Scholar 

  5. Ozaki T, Sugihara M, Nakatsuka Y, Kawai A, Inoue H (1996) Polyostotic fibrous dysplasia. A long-term follow up of 8 patients. Int Orthop 20:227–232

    Article  PubMed  CAS  Google Scholar 

  6. Enneking WF, Gearen PF (1986) Fibrous dysplasia of the femoral neck. Treatment by cortical bone-grafting. J Bone Joint Surg Am 68:1415–1422

    PubMed  CAS  Google Scholar 

  7. Guille JT, Kumar SJ, MacEwen GD (1998) Fibrous dysplasia of the proximal part of the femur. Long-term results of curettage and bone-grafting and mechanical realignment. J Bone Joint Surg Am 80:648–658

    PubMed  CAS  Google Scholar 

  8. Connolly JF (1977) Shepherd’s Crook deformities of polyostotic fibrous dysplasia treated by osteotomy and Zickel nail fixation. Clin Orthop Relat Res 123:22–24

    PubMed  Google Scholar 

  9. Kataria H, Sharma N, Kanojia RK (2009) 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. J Orthop Surg (Hong Kong) 17:245–247

    Google Scholar 

  10. DiCaprio MR, Enneking WF (2005) Fibrous dysplasia. Pathophysiology, evaluation, and treatment. J Bone Joint Surg Am 87:1848–1864

    Article  PubMed  Google Scholar 

  11. Keijser LC, Van Tienen TG, Schreuder HW, Lemmens JA, Pruszczynski M, Veth RP (2001) Fibrous dysplasia of bone: management and outcome of 20 cases. J Surg Oncol 76:157–166

    Article  PubMed  CAS  Google Scholar 

  12. Jung ST, Chung JY, Seo HY, Bae BH, Lim KY (2006) Multiple osteotomies and intramedullary nailing with neck cross-pinning for shepherd’s crook deformity in polyostotic fibrous dysplasia: 7 femurs with a minimum of 2 years follow-up. Acta Orthop 77:469–473

    Article  PubMed  Google Scholar 

  13. Watanabe K, Tsuchiya H, Sakurakichi K, Matsubara H, Tomita K (2007) Double-level correction with the Taylor Spatial Frame for shepherd’s crook deformity in fibrous dysplasia. J Orthop Sci 12:390–394

    Article  PubMed  Google Scholar 

  14. Russell LW, Chandler FA (1950) Fibrous dysplasia of bone. J Bone Joint Surg Am 32:321–337

    Google Scholar 

  15. Chen WJ, Chen WM, Chiang CC, Huang CK, Chen TH, Lo WH (2005) Shepherd’s crook deformity of polyostotic fibrous dysplasia treated with corrective osteotomy and dynamic hip screw. J Chin Med Assoc 68:343–346

    Article  PubMed  Google Scholar 

  16. Yang L, Jing Y, Hong D, Chong-Qi T (2010) Valgus osteotomy combined with intramedullary nail for Shepherd’s crook deformity in fibrous dysplasia: 14 femurs with a minimum of 4 years follow-up. Arch Orthop Trauma Surg 130:497–502

    Article  PubMed  Google Scholar 

  17. Freeman BH, Bray EW 3rd, Meyer LC (1987) Multiple osteotomies with Zickel nail fixation for polyostotic fibrous dysplasia involving the proximal part of the femur. J Bone Joint Surg Am 69:691–698

    PubMed  CAS  Google Scholar 

  18. Ippolito E, Bray EW, Corsi A et al (2003) Natural history and treatment of fibrous dysplasia of bone: a multicenter clinicopathologic study promoted by the European Pediatric Orthopaedic Society. J Pediatr Orthop B 12:155–177

    PubMed  Google Scholar 

Download references

Conflict of interest

This project had no financial support, and the authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, the Second Affiliated Hospital, Medical College of Zhejiang University, No. 88, Jiefang Road, Hangzhou, 310009, China

    Weixu Li, Xin Huang, Zhaoming Ye, Disheng Yang, Huimin Tao, Nong Lin & Zhengming Yang

Authors
  1. Weixu Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xin Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhaoming Ye
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Disheng Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Huimin Tao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nong Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zhengming Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xin Huang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Li, W., Huang, X., Ye, Z. et al. Valgus osteotomy in combination with dynamic hip screw fixation for fibrous dysplasia with shepherd’s crook deformity. Arch Orthop Trauma Surg 133, 147–152 (2013). https://doi.org/10.1007/s00402-012-1633-1

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-012-1633-1

Keywords

Search

Navigation