Abstract
Intramedullary fixation of the long bones is commonly used to prevent and treat fractures and subsequent deformities in patients with osteogenisis imperfecta. However, there is little in the literature about the management of deformities of the proximal femur, such as coxa vara secondary to malunited proximal fractures. This paper presents a simple surgical technique that holds the femoral neck in a valgus position in osteogenisis imperfecta.
Four patients (five hips) presented with an acute fracture of the upper femur and complex proximal deformity with coxa vara. All patients, whose mean age at operation was 6.5 years, were classified as Sillence type III, and none had previously undergone surgery. The femoral deformity was corrected and the femur stabilised with a Williams rod. The unstable proximal segment and femoral neck were fixed with K-wires, which were then bent and secured to the femoral shaft with two cerclage wires.
Patients were followed up to radiological union. Pre-operatively the mean neck-shaft angle was 70°, and there were associated complex deformities of the proximal femur and femoral shaft. At the time of surgery, a mean correction of neck-shaft angle of 60( was achieved, giving a mean valgus angle of 130°. The correction was maintained at follow-up. One patient remained ambulant after surgery, two subsequently became ambulant with elbow crutches and one remained non-ambulant.
The abstracts were edited by Prof. M.B.E. Sweet. Correspondence should be addressed to him at the Department of Orthopaedic Surgery, Medical School, University of the Witwatersrand, 7 York Road, Parktown, 2193 South Africa
