Hip Pelvis.  2018 Mar;30(1):53-59. 10.5371/hp.2018.30.1.53.

Pauwels Osteotomy for Femoral Neck Nonunion in Two Adult Siblings with Osteogenesis Imperfecta

• Kloen P
• Donders JC
• Eekhoff EM
• Hamdy RC

• KMID: 2408186
• DOI: http://doi.org/10.5371/hp.2018.30.1.53

Abstract

This is a retrospective review of two adult siblings with osteogenesis imperfecta (OI) type III (according to Sillence classification), who sustained a spontaneous femoral neck fracture and subsequent nonunion. The diagnosis of OI in these two patients was made based on clinical, radiological and genetic findings. The fracture was most likely caused by femoroacetabular impingement secondary to OI induced acetabular protrusio. A valgus osteotomy according to Pauwels'principles and fixation of the osteotomy and nonunion with a locking plate resulted in healing despite compromised bone quality and limited bone stock. Long-term follow up (4.5 years and 6.5 years, respectively) is provided. When treating this difficult problem, improving the mechanobiological environment and decreasing the femoroacetabular impingement by a Pauwels type osteotomy should be considered.

Keyword

Osteogenesis imperfecta; Osteotomy; Nonunion; Femoral neck

MeSH Terms

Acetabulum
Adult*
Diagnosis
Femoracetabular Impingement
Femoral Neck Fractures
Femur Neck*
Follow-Up Studies
Humans
Osteogenesis Imperfecta*
Osteogenesis*
Osteotomy*
Retrospective Studies
Siblings*

Figure

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  Fig. 1 (A–C) Anteroposterior radiographs. (A) The right sided femoral neck fracture. A femoral nail is still in situ from previous fixation. (B) Subtrochanteric fracture at 2.5 months after initial surgery. (C) The revision fixation. (D) Axial computed tomography of the hip showing impingement of the acetabulum on the femoral neck.

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  Fig. 2 Sequential fluoroscopic images showing the Pauwels osteotomy, (A, B); fixation and interposition of fibular allograft (C, D).

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  Fig. 3 Anteroposterior pelvic radiograph at 2.5 years postoperatively shows the healed nonunion and osteotomies of the right femur as well as the healed reconstruction of the left proximal femur.

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  Fig. 4 Coronal computed tomographic images at 4.5 years after the Pauwels osteotomy. (A) The healed femoral neck. (B) The healed proximal femur.

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  Fig. 5 (A–C) Anteroposterior radiographs. (A) Femoral neck fracture with severe acetabular protrusion and coxa vara. (B) Initial fixation with a long plate and one locking screw in the neck. (C) After osteotomies and revision fixation. (D) Axial computed tomographic image confirms healing of the femoral neck nonunion at 2 months after the last surgery.

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