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Surgical treatment for shepherd’s crook deformity in fibrous dysplasia: THERE IS NO BEST, ONLY BETTER

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Abstract

Background

The optimal strategy for shepherd’s crook deformity correction remains technically challenging. In particular, it is difficult to perform an accurate osteotomy based on the pre-operative correction plan. Moreover, the choice of ideal hardware remains unclear. In addition, when combined with the deformity of knee joint, the sequence of deformity correction is another overlooked factor when making a correction strategy.

Methods

From February 2012 to March 2014, we retrospectively examined a cases series in our department involving the creation of three-dimensional (3D) printing osteotomy templates and inner fixation for shepherd’s crook deformity in fibrous dysplasia.

Results

A total of ten patients of shepherd’s crook deformity were enrolled in this study. The neck shaft angle was corrected from a mean value of 88.1° (range, 73–105°) pre-operatively to a mean value of 128.5° (range, 120–135°) post-operatively; no marked loss in the value was observed (mean, 123.7°; range, 115–130°) at the final follow-up. In addition, compared with patients using dynamic hip screw (DHS), longer operation time and additional blood loss were recorded in patients using intramedullary nail (IN). Moreover, after correction of shepherd’s crook deformity, two patients were observed more predominant on their pre-existing valgus knee deformity.

Conclusions

3D printing osteotomy templates facilitate the correction of shepherd’s crook deformity. Dynamic hip screw (DHS), combined with polymethylmethacrylate (PMMA) augmentation, yields excellent outcomes and ensures easy placement and non-intramedullary manipulation, lower bleeding volume, and reduced operation time. Prior to the correction of shepherd’s crook deformity, the mechanical axis of the lower limb should be carefully examined, and any evidence of valgus knee deformity should be addressed in advance.

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Acknowledgements

We would like to give our sincere thanks to Dr. Qing Liu, Dr. Wei Luo, Dr. Zhan Liao, Dr. Feng Long, and Dr. Jian Tian for data collection and Miss. Jing Wan (the wife of Dr. Jun Wan) for her selfless support during the study.

Funding

The study was supported by the National Natural Science Foundation of China (No. 81301671).

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Authors and Affiliations

  1. Department of Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87#, Changsha, 410008, Hunan Province, People’s Republic of China

    Wan Jun, Zhang Can, Liu Yu-peng & He Hong-bo

Authors
  1. Wan Jun
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  2. Zhang Can
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  3. Liu Yu-peng
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  4. He Hong-bo
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Corresponding author

Correspondence to He Hong-bo.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by ethical committee of Xiangya Hospital (document attached as follows).

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Wan, J., Zhang, C., Liu, Yp. et al. Surgical treatment for shepherd’s crook deformity in fibrous dysplasia: THERE IS NO BEST, ONLY BETTER. International Orthopaedics (SICOT) 43, 719–726 (2019). https://doi.org/10.1007/s00264-018-4074-9

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  • DOI: https://doi.org/10.1007/s00264-018-4074-9

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