Various kinds of surgical treatments have been reported for varus
deformity of the proximal femur due to fibrous dysplasia. We report a case of two-stage corrective
osteotomy for severe varus-retroversion
deformity of the femoral neck due to
monostotic fibrous dysplasia. The patient was an 18 year-old man. On initial examination, the spina malleollar distance was 88 cm on the right side and 83 cm on the left. Plain radiography showed prominent varus
deformity of his left proximal femur. The morphology was 130 degrees on the right side and 85 degrees on the left. Computed tomography revealed 60 degree retroversion of the femoral neck. A two-stage surgery was performed, consisting of
curettage and
bone grafting followed by corrective
osteotomy 16 months later. A 55 degree valgus
osteotomy was performed in the subtrochanteric region. After
osteotomy and 40 degree internal rotation of the shaft,
a 130 degree angle plate was used for osteosynthesis. Postoperative radiological examination showed a morphology of 140 degrees and computed tomography revealed a 20 degree retroversion of the femoral neck. No recurrence or varus
deformity was seen at four years after surgery. Although the leg length discrepancy was 2.5 cm, the patient had no difficulty in one foot standing and no restriction of
ADL (activity of daily living). The well-known progressive varus Shepherd's crook
deformity in the polyostotic form of fibrous
dysphasia is associated with limb shortening, limping, and occasionally chronic
fatigue fractures with disabling
pain. Various kinds of surgical treatments have been reported for this type of varus
deformity.
Curettage and
bone grafting is one of the most common and simple treatments. However, this method often gives bad results as the grafted bones are absorbed and that the progress of varus
deformity van not to be prevented. We report a case of two-stage corrective osteomy forsevere varus-retroversion
deformity of the femoral neck due to
monostotic fibrous dysplasia.