Literature DB >> 24932048

Modified valgus osteotomy of the femoral neck for late presenting femoral neck stress fractures in military recruitsw.

Satya Prakash Singh1, Yashwant Tanwar1, Atin Jaiswal2, Masood Habib1.   

Abstract

Entities:  

Year:  2014        PMID: 24932048      PMCID: PMC4052041          DOI: 10.4103/0019-5413.132538

Source DB:  PubMed          Journal:  Indian J Orthop        ISSN: 0019-5413            Impact factor:   1.251


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Sir, We read the article by Sen et al.1 with great interest. The authors have done modified valgus osteotomy of femoral neck for displaced tensile stress fracture in an adult with good result. However, we have a few concerns. The authors have taken care to see that they do not disturb the posterior capsule and, so, the medial circumflex artery. But posterior capsule is naturally preserved because capsule is deficient posteriorly at the lateral third of neck; more so, the osteotomy site is toward trochanteric fossa, so it is totally protected. But my concern is about lateral ascending artery which traverses the capsule at posterior trochanteric fossa and is present exactly at the osteotomy site. This is a major blood supply to the femoral head, neck, and to the trochanter in the adult.2 We would like to know how the authors managed it. This study states that osteotomy leads to shortening of femoral neck and the abductor lever arm, resulting in diminished efficiency of abductors, which is clearly evident in the figures in the article. Many studies have evaluated the importance of femoral neck length influencing the functional outcome. Zlowodzki et al.3 reported that femoral neck shortening had a negative impact on the SF-36 score. Similarly, Boraiah et al.4 reported that bodily pain subscore of the SF-36 correlated with the “abductor lever arm.” So, how will the authors justify changing the anatomy of proximal femur and its biomechanics? The authors have stressed about inferomedial osteoperiosteal hinge to maintain the continuity of bony trabeculae which has an important role in union. We would like to know how the authors managed to maintain the trabeculae in partially displaced varus fracture, that too, after the abduction osteotomy and multiple bone drilling.
  4 in total

1.  Arterial supply of the femoral head. A combined angiographic and histological study.

Authors:  L G Wertheimer; S de L Lopes
Journal:  J Bone Joint Surg Am       Date:  1971-04       Impact factor: 5.284

2.  Predictable healing of femoral neck fractures treated with intraoperative compression and length-stable implants.

Authors:  Sreevathsa Boraiah; Omesh Paul; Sommer Hammoud; Michael J Gardner; David L Helfet; Dean G Lorich
Journal:  J Trauma       Date:  2010-07

3.  Femoral neck shortening after fracture fixation with multiple cancellous screws: incidence and effect on function.

Authors:  Michael Zlowodzki; Olufemi Ayeni; Olufemi Ayieni; Brad A Petrisor; Mohit Bhandari
Journal:  J Trauma       Date:  2008-01

4.  Modified valgus osteotomy of the femoral neck for late presenting femoral neck stress fractures in military recruits.

Authors:  Ramesh Kumar Sen; Sujit Kumar Tripathy; Shakthivel Rr Manoharan; Somya Chakrabarty
Journal:  Indian J Orthop       Date:  2013-09       Impact factor: 1.251

  4 in total
  1 in total

1.  Author's reply.

Authors:  Sujit Kumar Tripathy; Ramesh Kumar Sen; Shakthivel Rr Manoharan; Somya Chakrabarty
Journal:  Indian J Orthop       Date:  2014-05       Impact factor: 1.251

  1 in total

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