Intramedullary internal fixation for the treatment of fibrous dysplasia of proximal femur combined with coxa varus deformity

doi:10.3969/j.issn.2095-4344.2013.26.008

Abstract

Abstract:

BACKGROUND: The surgical treatment for fibrous dysplasia of the proximal femur combined with coxa varus deformity must be carried out in order to restore the mechanical axis of the femur as far as possible. Though, there are various osteotomy programs, wedging valgus osteotomy has predominated. There are more complications after extramedullary fixation, such as screws and screw-plate systems, and the long-term stable therapeutic effect cannot be reached. Studies have shown that the wedging valgus osteotomy at the proximal femur and interlocking intramedullary nail fixation can obtain better medium- and long-term therapeutic effect.
OBJECTIVE: To investigate the intramedullary internal fixation method for the treatment of fibrous dysplasia of proximal femur combined with coxa varus deformity, and to investigate the biocompatibility.
METHODS: A total of 23 patients with fibrous dysplasia of proximal femur combined with coxa varus and limb reduction deformities were adopted and treated. The mean femoral neck-shaft angle was 79° in average (range 56°-110°). The relative femoral length was 4.0 cm shorter on average (range 1.9-8.9 cm) than that of the opposite side. All patients were treated with wedging valgus osteotomy in the proximal femur, curettage, autogenous rib bone-grafting and interlocking intramedullary nail internal fixation.
RESULTS AND CONCLUSION: Postoperatively, 19 patients were followed-up for an average period of 1 year (range 6 months to 2 years). All internal fixations were stable. The mechanical axis of femur was just corrected, all patients got bone healing. Postoperative neck-shaft angle was corrected to 112°on average (range 90°-125°) and the average relative length of femur was increased by 2.0 cm on average (range 1.5-2.5 cm), and there was no significant effect on hip function. After surgery, three patients could walk normally without claudication, seven patients could walk with crutches, five patients ambulated with a unilateral cane and four patients were slightly limbing without support. Pain disappeared in 12 patients, pain was significantly improved in six patients, and pain aggravated and new pain appeared in one patient. No infection, refracture or progression of deformity occurred in the patients. The surgical treatment method of wedging valgus osteotomy in the proximal femur, curettaging, autogenous rib bone-grafting and interlocking intramedullary nail internal fixation have good effect for fibrous dysplasia of proximal femur combined with coxa varus and limb reduction deformity. This method can not only reduce the mass of bone-grafting and fully correct deformity, but also can prevent recurrence of the deformity. And meanwhile, the middle-term follow-up observation confirms that the osteotomy surface get bone healing, and hip function is significantly improved with good biocompatibility.

Key words: bone and joint implants, bone and joint implants, proximal femur, fibrous dysplasia of bone, coxa varus deformity, wedging valgus osteotomy, mechanical axis, bone graft, internal fixation, interlocking intramedullary nail, biocompatibility

CLC Number:

R318

Yu Xiao-kui, Zhu Bing, Sun Tian-sheng, Qin Fa-bin, Ma Qing-song . Intramedullary internal fixation for the treatment of fibrous dysplasia of proximal femur combined with coxa varus deformity[J]. Chinese Journal of Tissue Engineering Research, doi: 10.3969/j.issn.2095-4344.2013.26.008.

Figures/Tables 2

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