Hip Preservation Surgery by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783662611869
Publisher: Springer Berlin Heidelberg

Simply applying traction along the line of the femur will naturally cause the osteotomy line to open. The line should be incomplete, and the lateral part should again be created as for a guided bone fracture. The medial section of the line is then opened by putting the orthopaedic table in traction.

It is quite possible and even desirable to improve the outcome and avoid any loss of correction upon weight-bearing, to insert a hydroxyapatite wedge into the open line (Fig. 13.5b).

However, the fixation process is trickier, because the cannulated screw must not create any new compression which would close the line. I recommend using a large diameter fully threaded cortical screw as close as possible to the medical cortex into the femoral neck where the bone stock quality is highest. A second more lateral screw will maintain a good degree of compression on the lateral part of the line. In addition, here the screw will embed into the cancellous bone of the greater trochanter (Fig. 13.5c).

A wedge could be harvested from the iliac crest in order to fill the gap, but this would be insufficient on its own to produce the desired degree of valgus. When the patient tries to bear weight on the region, the line will be unable to close and crush the wedge. The medial-most fully threaded screw will be more effective if seated in the lateral cortex of the lateral diaphysis and firmly embedded in the head (Fig. 13.6).

Fig. 13.6Valgization example: treatment of FAI and coxa vara with the same procedure

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