Clin Orthop Surg.  2016 Sep;8(3):310-315. 10.4055/cios.2016.8.3.310.

Fixation of Intertrochanteric Valgus Osteotomy with T Plate in Treatment of Developmental Coxa Vara

• Elzohairy
• Khairy HM

• KMID: 2374278
• DOI: http://doi.org/10.4055/cios.2016.8.3.310

Abstract

BACKGROUND
Although the valgus subtrochanteric osteotomy is considered as a standard surgical treatment for coxa vara, there is no consensus on the optimal method of fixation and osteotomy technique. Fixation of the osteotomy has been achieved by various methods including external fixation and internal fixation with pins and cerclage and a variety of plates. The aim of this study is the evaluation of the results of developmental coxa treated by Y intertrochanteric valgus osteotomy fixed with a T-buttress plate compared with other methods of fixation in the literature.
METHODS
Eighteen corrective valgus intertrochanteric femoral osteotomies were performed in 18 patients (18 hips) for treatment of unilateral developmental coxa vara deformity and fixed with a T plate. There were 12 males and 6 females. The right hip was affected in 10 patients and the left hip in 8 patients. Clinically, patients were evaluated by Larson hip score. Radiographically, anteroposterior view of the pelvis and frog leg lateral views of the affected hip were taken preoperatively and compared with the findings at the final follow-up.
RESULTS
The average follow-up was 29 months (range, 24 to 36 months). Clinical results showed improvement of the mean Larson hip score from 57.8 to 97.0 (p < 0.001). Radiological results showed that all osteotomies were completely united in 2.4 months (range, 2 to 3 months) with the achievement of the planned correction angle. The average correction of Hilgenreiner's epiphyseal angle improved from 78.2° to 27.8° (p < 0.001) at the final follow-up. The femoral neck shaft angle was improved from 93.7° to 129.9° (p < 0.001) at the final follow-up. Shortening of the affected limb was corrected from 2.8 cm to 1.3 cm (p < 0.001) at the last follow-up. No major serious complications were recorded in the present study.
CONCLUSIONS
Intertrochanteric valgus osteotomy of the proximal femur fixed with a T plate may be efficient for treatment of developmental coxa vara. With careful planning, it can result in a low complication rate and insignificant or minimal recurrence rate.

Keyword

Coxa vara; Osteotomy; Intertrochanteric valgus; T plate; Fixation

MeSH Terms

*Bone Plates
Child
Child, Preschool
Coxa Vara/*surgery
Female
Femur Neck/*surgery
Follow-Up Studies
*Fracture Fixation, Internal/instrumentation/methods/statistics & numerical data
Humans
Male
*Osteotomy/methods/statistics & numerical data

Figure

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  Fig. 1 The preoperative planning and drawing of the wedge for the Y-shaped intertrochanteric osteotomy.

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  Fig. 2 The postoperative anteroposterior (A) and frog leg lateral (B) radiographs showed complete osteotomy union at 3 months follow-up.

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  Fig. 3 The X-ray shows no recurrence of deformity after plate removal at 36 months follow-up.

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