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

  • Wan Jun 
  • Zhang Can 
  • Liu Yu-peng 
  • He Hong-bo 
Original Paper
  • 27 Downloads

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.

Keywords

Shepherd’s crook deformity Fibrous dysplasia 3D printing osteotomy template Hardware Knee deformity 

Notes

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).

Compliance with ethical standards

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).

Supplementary material

264_2018_4074_MOESM1_ESM.mp4 (2.5 mb)
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264_2018_4074_MOESM2_ESM.mp4 (2 mb)
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264_2018_4074_MOESM3_ESM.docx (186 kb)
ESM 3 (DOCX 186 kb)

References

  1. 1.
    DiCaprio MR, Enneking WF (2005) Fibrous dysplasia. Pathophysiology, evaluation, and treatment. J Bone Joint Surg Am 87:1848–1864PubMedGoogle Scholar
  2. 2.
    Ippolito E, Farsetti P, Boyce AM, Corsi A, De Maio F, Collins MT (2014) Radiographic classification of coronal plane femoral deformities in polyostotic fibrous dysplasia. Clin Orthop Relat Res 472:1558–1567CrossRefPubMedGoogle Scholar
  3. 3.
    Ippolito E, Valentini MB, Lala R, De Maio F, Sorge R, Farsetti P (2016) Changing pattern of femoral deformity during growth in polyostotic fibrous dysplasia of the bone: an analysis of 46 cases. J Pediatr Orthop 36:488–493CrossRefPubMedGoogle Scholar
  4. 4.
    Guille JT, Kumar SJ, MacEwen GD (1998) Fibrous dysplasia of the proximal part of the femur. Long-term results of curettage and bone-grafting and mechanical realignment. J Bone Joint Surg Am 80:648–658CrossRefPubMedGoogle Scholar
  5. 5.
    Al-Mouazzen L, Rajakulendran K, Ahad N (2013) Fibrous dysplasia, shepherd's crook deformity and an intra-capsular femoral neck fracture. Strategies Trauma Limb Reconstr 8:187–191CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Hagiwara Y, Iwata S, Yonemoto T, Ishii T (2015) Rotational valgus osteotomy for shepherd's crook deformity: a case report. J Orthop Sci 20:422–424CrossRefPubMedGoogle Scholar
  7. 7.
    Hefti F, Donnan L, Krieg AH (2017) Treatment of shepherd's crook deformity in patients with polyostotic fibrous dysplasia using a new type of custom made retrograde intramedullary nail: a technical note. J Child Orthop 11:64–70CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Watanabe K, Tsuchiya H, Sakurakichi K, Matsubara H, Tomita K (2007) Double-level correction with the Taylor Spatial Frame for shepherd’s crook deformity in fibrous dysplasia. J Orthop Sci 12:390–394CrossRefPubMedGoogle Scholar
  9. 9.
    Zhang XL, Chen CY, Duan H, Tu CQ (2016) Multiple valgus osteotomies combined with intramedullary nail for shepherd's crook deformity in polyostotic fibrous dysplasia: a case series and review of the literature. Int J Clin Exp Med 9:1942–1952Google Scholar
  10. 10.
    Sakurakichi K, Tsuchiya H, Yamashiro T, Watanabe K, Matsubara H, Tomita K (2008) Ilizarov technique for correction of the Shepherd's crook deformity: a report of two cases. J Orthop Surg (Hong Kong) 16:254–256CrossRefGoogle Scholar
  11. 11.
    Jung ST, Chung JY, Seo HY, Bae BH, Lim KY (2006) Multiple osteotomies and intramedullary nailing with neck cross-pinning for shepherd's crook deformity in polyostotic fibrous dysplasia: 7 femurs with a minimum of 2 years follow-up. Acta Orthop 77:469–473CrossRefPubMedGoogle Scholar
  12. 12.
    Tong Z, Zhang W, Jiao N, Wang K, Chen B, Yang T (2013) Surgical treatment of fibrous dysplasia in the proximal femur. Exp Ther Med 5:1355–1358CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Chen WJ, Chen WM, Chiang CC, Huang CK, Chen TH, Lo WH (2005) Shepherd's crook deformity of polyostotic fibrous dysplasia treated with corrective osteotomy and dynamic hip screw. J Chin Med Assoc 68:343–346CrossRefPubMedGoogle Scholar
  14. 14.
    Dumitrescu CE, Collins MT (2008) McCune-Albright syndrome. Orphanet J Rare Dis 19:12CrossRefGoogle Scholar
  15. 15.
    Wan J, He HB, Liao QD, Zhang C (2014) An atypical monomelic presentation of Mazabraud syndrome. Indian J Orthop 48:429–431CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Honigmann P, Thieringer F, Steiger R, Haefeli M, Schumacher R, Henning J (2016) A simple 3-dimensional printed aid for a corrective palmar opening wedge osteotomy of the distal radius. J Hand Surg Am 41:464–469CrossRefPubMedGoogle Scholar
  17. 17.
    Zhang YZ, Lu S, Chen B, Zhao JM, Liu R, Pei GX (2011) Application of computer-aided design osteotomy template for treatment of cubitus varus deformity in teenagers: a pilot study. J Shoulder Elb Surg 20:51–56CrossRefGoogle Scholar
  18. 18.
    Chen X, Xu L, Wang W, Li X, Sun Y, Politis C (2016) Computer-aided design and manufacturing of surgical templates and their clinical applications: a review. Expert Rev Med Devices 13:853–864CrossRefPubMedGoogle Scholar
  19. 19.
    Zheng P, Yao Q, Xu P, Wang L (2017) Application of computer-aided design and 3D-printed navigation template in Locking Compression Pediatric Hip Plate placement for pediatric hip disease. Int J Comput Assist Radiol Surg 12:865–871CrossRefPubMedGoogle Scholar
  20. 20.
    Ippolito E, Farsetti P, Valentini MB, Potenza V (2015) Two-stage surgical treatment of complex femoral deformities with severe coxa vara in polyostotic fibrous dysplasia. J Bone Joint Surg Am 97:119–125CrossRefPubMedGoogle Scholar
  21. 21.
    Kataria H, Sharma N, Kanojia RK (2009) One-stage osteotomy and fixation using a long proximal femoral nail and fibular graft to correct a severe shepherd's crook deformity in a patient with fibrous dysplasia: a case report. J Orthop Surg (Hong Kong) 17:245–247CrossRefGoogle Scholar
  22. 22.
    Yang L, Jing Y, Hong D, Chong-Qi T (2010) Valgus osteotomy combined with intramedullary nail for Shepherd's crook deformity in fibrous dysplasia: 14 femurs with a minimum of 4 years follow-up. Arch Orthop Trauma Surg 130:497–502CrossRefPubMedGoogle Scholar
  23. 23.
    Li W, Huang X, Ye Z, Yang D, Tao H, Lin N, Yang Z (2013) Valgus osteotomy in combination with dynamic hip screw fixation for fibrous dysplasia with shepherd's crook deformity. Arch Orthop Trauma Surg 133:147–152CrossRefPubMedGoogle Scholar
  24. 24.
    Paley D, Tetsworth K (1992) Mechanical axis deviation of the lower limbs: preoperative planning of uniapical angular deformities of the tibia or femur. Clin Orthop Relat Res 280:48–64Google Scholar
  25. 25.
    Paley D, Herzenberg JE, Tetswoth K, McKie J, Bhave A (1994) Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am 25:425–465PubMedGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Orthopaedics, Xiangya HospitalCentral South UniversityChangshaPeople’s Republic of China

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