Femoral neck stress fractures (FNSFs) are rare, constituting only 5% of all stress fractures in young adults. These fractures are usually seen in athletes, military recruits and patients with underlying metabolic diseases. The treatment of FNSFs is still controversial because of the inherent complications associated with the treatment procedure. We came across 4 cases of bilateral FNSFs in non-athletic individuals who were manual labourers without underlying bony disorders. Two patients with FNSFs and coxa vara deformity on both sides were managed by subtrochanteric valgus osteotomy and dynamic hip screw fixation. One of the remaining two patients was treated by cannulated cancellous screw fixation on one side and subtrochanteric valgus osteotomy on the other side. The fourth patient received subtrochanteric valgus osteotomy on one side and bipolar hemiarthroplasty on the other side after failed cannulated screw fixation. All the fractures healed without any complications. No evidence of avascular necrosis or arthritis was noted in our series. Subtrochanteric valgus osteotomy restores normal neck-shaft angle in patients suffering from FNSFs combined with coxa vara deformity. Moreover, it helps to bring the forces acting around the hip to normal biomechanical levels, leading to fracture union and better results. Replacement arthroplasty is recommended to patients who fail to achieve bony union after fixation.
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J Orthop Case Rep
October 2024
Department of Orthopaedics, Dr. Muthus Super Speciality Orthopaedic Hospital, Singanallur, Coimbatore, Tamil Nadu, India.
J Orthop
July 2024
Department of Surgical Sciences, University of Turin, 10124, Turin, Italy.
Background: Developmental Coxa Vara (DCV) consists on a pathological reduction in head-shaft angle (HSA) and increased femoral retroversion. Several case series reported outcomes on proximal femoral valgus osteotomy (PFVO), but no evidence synthesis had been conducted. This systematic review aimed to (1) analyze success rate and complications, (2) report the degree of correction according to the HSA and the Hilgenreiner Epiphyseal Angle (HEA), compare success rate and degree of correction of subtrochanteric (SVO) vs intertrochanteric (IVO) osteotomy, and (4) difference in success rate and correction between patients in which an internal (IF) or external fixation (EF) technique was used.
View Article and Find Full Text PDFJ Pediatr Orthop
April 2024
Department of Orthopedics and Traumatology, Hand and Reconstructive Microsurgery Center, Assiut University Hospitals and School of Medicine, Assiut, Egypt.
Background: Septic necrosis of the femoral head and neck in children represents a challenging problem. Several reconstructive techniques have been described but with disappointing long-term results. Vascularized epiphyseal transfer utilizing the proximal fibula have been successfully used for reconstruction of the proximal humerus and distal radius and only scarcely used for hip reconstruction.
View Article and Find Full Text PDFInt Orthop
April 2024
Department of Orthopaedic Surgery, Mansoura University Hospital, Mansoura University, Mansoura, 7650001, Egypt.
Purpose: Re-revision of subtrochanteric non-unions is technically challenging and lacks robust evidence. The results of managing subtrochanteric fractures after multiple failed procedures have rarely been reported in the literature. This study aims to evaluate the effect of valgus reduction on non-united subtrochanteric fractures with single or multiple failed revision surgeries.
View Article and Find Full Text PDFJ Pediatr Orthop
January 2024
Department of Pediatric Orthopaedic Surgery, Children's Hospital Hamburg-Altona.
Background: Various salvage surgical procedures for painful hip dislocation in adolescent patients with cerebral palsy exist. To date, no significant differences among these surgical techniques have been described. In our institution the McHale procedure is the standard of care for painful chronically dislocated hips with or without deformity of the femoral head in patients with cerebral palsy.
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