Acta Scientific Orthopaedics (ISSN: 2581-8635)

Case Report Volume 5 Issue 1

Management of Shepherd’s Crook Deformity by Proximal Femoral Osteotomy without Bone Graft - A Case Report

Avijit Basak, Kunal Mondal*, Pinaki Das, Raunak Agarwal and Subhasish Manna

Department of Orthopaedics, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karni Memorial Hospital, West Bengal, India

*Corresponding Author: Kunal Mondal, Department of Orthopaedics, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karni Memorial Hospital, West Bengal, India.

Received: November 01,2021; Published: December 14, 2021

Abstract

Introduction: Fibrous dysplasia is a benign condition of the skeletal system. In this disorder there is fibro-osseous proliferation with intervening areas of normal or immature bone in the intramedullary region. This is a case report reflecting management a case of unilateral shepherd’s crook deformity at right proximal femur with microfractures causing functional restrictions.

Case Report: A 19-year-old female presented with pain and shortening of right lower limb. Radiographs and histopathology suggestive of fibrous dysplasia. On the right side, we did a valgus close wedged osteotomy in the subtrochanteric region and fixed with dynamic condylar screw supported by 95-degree barrel plate without introducing any bone graft. Patient was followed up for 1 year and ends up with a better functional outcome evaluated by Harris hip score and Oxford hip score.

Conclusion: Lateral close wedged osteotomy is effective method to correct the shepherd’s crook deformity if properly executed. Hence using an extramedullary device without bone graft can be the choice of treatment in such cases.

Keywords: Fibrous Dysplasia; Shepherd’s Crook Deformity; Lateral Close Wedged Osteotomy; Dynamic Condylar Screw; 95-Degree Barrel Plate; Extramedullary Device; Bone Graft

References

  1. Alman BA., et al. “Activating mutations of Gs protein in monostotic fibrous lesions of bone”. Journal of Orthopaedic Research 2 (1996): 311-315.
  2. DiCaprio MR and Enneking WF. “Fibrous dysplasia. Pathophysiology, evaluation, and treatment”. Journal of Bone and Joint Surgery 8 (2005): 1848-1864.
  3. Wei-Jen Chen, Wei-Ming Chen, Chao-Ching Chiang, Ching-Kuei Huang, Tain-Hsiung Chen, Wai-Hee Lo. Journal of the Chinese Medical Association 7 (2005): 343-346.
  4. Albright F., et al. “Syndrome characterized by osteitis fibrosa disseminata, areas of pigmentation and endocrine dysfunction, with precocious puberty in females”. New England Journal of Medicine 216 (1937): 727-746.
  5. Chapurlat RD., et al. “Treatment of fibrous dysplasia of bone with intravenous pamidronate: long-term effectiveness and evaluation of predictors of response to treatment”. Bone 1 (2004): 235-242.
  6. Liens D., et al. “Long-term effects of intravenous pamidronate in fibrous dysplasia of bone”. Lancet 8903 (1994): 953-954.
  7. Bernando Vagars. “Orthopaedic surgery for Fibrous Dysplasia medicine”. Medscape (2016).
  8. Guille JT., et al. “Fibrous dysplasia of the proximal part of the femur. Long-term results of curettage and bone-grafting and mechanical realignment”. Journal of Bone and Joint Surgery 5 (1998): 648-658.
  9. Lee SE., et al. “The diagnostic utility of the GNAS mutation in patients with fibrous dysplasia: meta-analysis of 168 sporadic cases”. Human Pathology 8 (2012): 1234-1242.
  10. DiCaprio MR and Enneking WF. “Fibrous dysplasia. Pathophysiology, evaluation, and treatment”. Journal of Bone and Joint Surgery 8 (2005): 1848-1864.
  11. Russell LW and Chandler FA. “Fibrous dysplasia of bone”. Journal of Bone and Joint Surgery 2 (1950): 323-337.
  12. Enneking WF and Grearen PF. “Fibrous dysplasia of the femoral neck. Treatment by cortical bone-grafting”. Journal of Bone and Joint Surgery 9 (1986): 1415-1422.
  13. Lane JM., et al. “Bisphosphonate therapy in fibrous dysplasia”. Clinical Orthopaedics and Related Research 382 (2001): 6-12.
  14. Chapurlat RD., et al. “Long-term effects of intravenous pamidronate in fibrous dysplasia of bone”. Journal of Bone and Mineral Research 10 (1997): 1746-1752.
  15. Ozaki T., et al. “Polyostotic fibrous dysplasia: a long term follows up of 8 patients”. International Orthopaedics4 (1996): 227-232.
  16. Breck LW. “Treatment of fibrous dysplasia of bone by total femoral plating and hip nailing”. Clinical Orthopaedics 82 (1972): 82-83.
  17. Connolly JF. “Shepherd’s crook deformity of polyostotic fibrous dysplasia treated by osteotomy and Zickel nail fixation”. Clinical Orthopaedics and Related Research 123 (1977): 22-24.
  18. Freeman BH., et al. “Multiple osteotomies with Zickel nail fixation for polyostotic fibrous dysplasia involving the proximal part of the femur”. Journal of Bone and Joint Surgery 5 (1987): 691-698.
  19. Guille JT., et al. “Fibrous dysplasia of the proximal part of the femur: long-term results of curettage and bone-grafting and mechanical realignment”. Journal of Bone and Joint Surgery 5 (1998): 648-658.
  20. Yamamoto T., et al. “Oblique wedge osteotomy for femoral diaphyseal deformity in fibrous dysplasia”. Clinical Orthopaedics 384 (2001): 245-249.
  21. Enneking WF. “Fibrous lesion originating in bone. In Musculoskeletal Tumor Surgery”. New York: Churchill- Livingstone (1983): 855-867.
  22. Campanacci M. “Fibrous dysplasia in Bone and Soft Tissue Tumors, 2nd edition”. New York: Springer-Verlag Wien (1999): 435-461.

Citation

Citation: Kunal Mondal., et al. “Management of Shepherd’s Crook Deformity by Proximal Femoral Osteotomy without Bone Graft - A Case Report".Acta Scientific Orthopaedics 5.1 (2022): 11-14.

Copyright

Copyright: © 2022 Kunal Mondal., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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