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Valgus sliding subtrochanteric osteotomy for neglected fractures of the proximal femur; surgical technique and a retrospective case series.

Gavaskar AS, Chowdary NT - J Orthop Surg Res (2013)

Bottom Line: There were significant improvements in the postoperative Pauwel's angle, neck shaft angle and Oxford hip score.There was no x ray evidence of avascular necrosis of the femoral head at one year follow-up.The sliding osteotomy technique is simple, does not need extensive pre operative planning or removal of bone from the proximal femur.

View Article: PubMed Central - HTML - PubMed

Affiliation: Dept of Trauma, Parvathy Hospital, Chennai, India. gavaskar.ortho@gmail.com

ABSTRACT

Background: Conventional technique of valgus osteotomy of the proximal femur involves removal of a partial or full thickness lateral based wedge from the peritrochanteric region. The purpose of this article is to describe a novel technique of valgus subtrochanteric osteotomy for proximal femur nonunion.

Methods: 11 patients with proximal femur nonunions {intracapsular fractures--7, extracapsular fractures--4} were treated using a new technique of sliding subtrochanteric osteotomy and DHS fixation. Outcomes analysed include radiological outcome in terms of improvement in Pauwel's angle, neck-shaft angle and evidence of radiological union at the nonunion site and osteotomy site. Other outcomes analysed include, measurement of limb length discrepancy and functional outcome assessment with Oxford hip score.

Results: Union at the nonunion site and the osteotomy site was achieved in all patients. There were significant improvements in the postoperative Pauwel's angle, neck shaft angle and Oxford hip score. Limb length discrepancy improved to less than 1 cm in all patients. There was no x ray evidence of avascular necrosis of the femoral head at one year follow-up.

Conclusions: The sliding osteotomy technique is simple, does not need extensive pre operative planning or removal of bone from the proximal femur.

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Related in: MedlinePlus

The barrel plate doesn’t sit on the shaft because of the varus deformity. Traction is released and the mobile distal fragment is abducted and secured to the plate using a plate holding clamp.
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Figure 3: The barrel plate doesn’t sit on the shaft because of the varus deformity. Traction is released and the mobile distal fragment is abducted and secured to the plate using a plate holding clamp.

Mentions: An oblique osteotomyw is done with an oscillating saw starting at the subtrochanteric region and directed towards the base of the lesser trochanter (Figure2).The pre-operative Pauwel’s angle minus 30 degrees, which was considered the desired Pauwel’s angle, gave the angle of the osteotomy. The 135 degrees barrel plate was then inserted over the lag screw. Since the lag screw has been inserted at much lesser angle, the 135 degree barrel plate will not sit on the lateral cortex (Figure 3). Traction was released and the limb was abducted in order to bring the shaft to the plate. Reduction of the shaft to the plate was done and maintained with a plate holding clamp. The limb was then brought to neutral with the barrel plate well secured to the bone to verify the neck shaft angle, Pauwel’s angle and the degree of lateralization of the distal fragment (Figure 4). The distal screws were inserted to secure the plate. The surgical technique was similar in both intra and extracapsular fractures, except that the derotational screw was not used for extracapsular fractures.


Valgus sliding subtrochanteric osteotomy for neglected fractures of the proximal femur; surgical technique and a retrospective case series.

Gavaskar AS, Chowdary NT - J Orthop Surg Res (2013)

The barrel plate doesn’t sit on the shaft because of the varus deformity. Traction is released and the mobile distal fragment is abducted and secured to the plate using a plate holding clamp.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3643861&req=5

Figure 3: The barrel plate doesn’t sit on the shaft because of the varus deformity. Traction is released and the mobile distal fragment is abducted and secured to the plate using a plate holding clamp.
Mentions: An oblique osteotomyw is done with an oscillating saw starting at the subtrochanteric region and directed towards the base of the lesser trochanter (Figure2).The pre-operative Pauwel’s angle minus 30 degrees, which was considered the desired Pauwel’s angle, gave the angle of the osteotomy. The 135 degrees barrel plate was then inserted over the lag screw. Since the lag screw has been inserted at much lesser angle, the 135 degree barrel plate will not sit on the lateral cortex (Figure 3). Traction was released and the limb was abducted in order to bring the shaft to the plate. Reduction of the shaft to the plate was done and maintained with a plate holding clamp. The limb was then brought to neutral with the barrel plate well secured to the bone to verify the neck shaft angle, Pauwel’s angle and the degree of lateralization of the distal fragment (Figure 4). The distal screws were inserted to secure the plate. The surgical technique was similar in both intra and extracapsular fractures, except that the derotational screw was not used for extracapsular fractures.

Bottom Line: There were significant improvements in the postoperative Pauwel's angle, neck shaft angle and Oxford hip score.There was no x ray evidence of avascular necrosis of the femoral head at one year follow-up.The sliding osteotomy technique is simple, does not need extensive pre operative planning or removal of bone from the proximal femur.

View Article: PubMed Central - HTML - PubMed

Affiliation: Dept of Trauma, Parvathy Hospital, Chennai, India. gavaskar.ortho@gmail.com

ABSTRACT

Background: Conventional technique of valgus osteotomy of the proximal femur involves removal of a partial or full thickness lateral based wedge from the peritrochanteric region. The purpose of this article is to describe a novel technique of valgus subtrochanteric osteotomy for proximal femur nonunion.

Methods: 11 patients with proximal femur nonunions {intracapsular fractures--7, extracapsular fractures--4} were treated using a new technique of sliding subtrochanteric osteotomy and DHS fixation. Outcomes analysed include radiological outcome in terms of improvement in Pauwel's angle, neck-shaft angle and evidence of radiological union at the nonunion site and osteotomy site. Other outcomes analysed include, measurement of limb length discrepancy and functional outcome assessment with Oxford hip score.

Results: Union at the nonunion site and the osteotomy site was achieved in all patients. There were significant improvements in the postoperative Pauwel's angle, neck shaft angle and Oxford hip score. Limb length discrepancy improved to less than 1 cm in all patients. There was no x ray evidence of avascular necrosis of the femoral head at one year follow-up.

Conclusions: The sliding osteotomy technique is simple, does not need extensive pre operative planning or removal of bone from the proximal femur.

Show MeSH
Related in: MedlinePlus