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Transfixing Kirshner wires for fixation of intertrochanteric valgus osteotomies in management of pediatric coxa vara

BACKGROUND: Coxa vara is a radiological term describing a decrease in the neck–shaft angle to 120° or less. Coxa vara is associated with pathomechanical changes that can manifest clinically. If left untreated, coxa vara can affect the normal development of the pediatric hip. Valgus osteotomy is the...

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Autor principal: Rizk, Ahmed Shawkat
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685981/
https://www.ncbi.nlm.nih.gov/pubmed/28702703
http://dx.doi.org/10.1007/s10195-017-0463-x
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author Rizk, Ahmed Shawkat
author_facet Rizk, Ahmed Shawkat
author_sort Rizk, Ahmed Shawkat
collection PubMed
description BACKGROUND: Coxa vara is a radiological term describing a decrease in the neck–shaft angle to 120° or less. Coxa vara is associated with pathomechanical changes that can manifest clinically. If left untreated, coxa vara can affect the normal development of the pediatric hip. Valgus osteotomy is the standard surgical treatment for coxa vara, but there is no consensus regarding the optimal osteotomy technique and fixation method. The work reported here aimed to highlight transfixing wires as a fixation method for valgus osteotomy applied as treatment for various types of pediatric coxa vara. MATERIALS AND METHODS: This study included 16 cases of pediatric coxa vara with different etiologies in 9 patients with a mean age of 39.9 ± 15.2 months. Radiological and clinical evaluations and scoring of the condition of each patient according to the Iowa Hip Score were performed pre- and postoperatively. Transfixing wires and a protective spica were used for the fixation of a V-shaped, laterally based, closing-wedge valgus osteotomy in all cases. The postoperative follow-up period ranged from 14 to 102 months, with a mean duration of 33.3 ± 27.7 months. RESULTS: The mean Hilgenreiner epiphyseal angle (HEA) was corrected from 81.7 ± 2.2° to 24.3 ± 3.5° and the mean femoral neck–shaft angle (FNSA) was improved from 86.9 ± 4.2° to 138.6 ± 3.5°. No recurrence of the deformity was observed during the follow-up periods considered here. The osteotomy site united after an average of 11.7 ± 2.2 weeks with no secondary displacement, and in cases of developmental coxa vara there was progressive ossification of the neck defect with no surgery-related complications. Clinical results were markedly improved by the osteotomy, with a mean postoperative Iowa Hip Score at last follow-up of 95.06 ± 2.6, compared to a mean preoperative score of 57.4 ± 3.6. CONCLUSIONS: Transfixing wires protected in a hip spica cast represent a simple, easy, and reliable fixation method for valgus osteotomies performed to correct pediatic coxa vara. It assures stable fixation and rapid healing of the osteotomy without loss of the achieved correction, it completely avoids the femoral neck affording marked protection to the growth plate. LEVEL OF EVIDENCE: IV.
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spelling pubmed-56859812017-11-28 Transfixing Kirshner wires for fixation of intertrochanteric valgus osteotomies in management of pediatric coxa vara Rizk, Ahmed Shawkat J Orthop Traumatol Original Article BACKGROUND: Coxa vara is a radiological term describing a decrease in the neck–shaft angle to 120° or less. Coxa vara is associated with pathomechanical changes that can manifest clinically. If left untreated, coxa vara can affect the normal development of the pediatric hip. Valgus osteotomy is the standard surgical treatment for coxa vara, but there is no consensus regarding the optimal osteotomy technique and fixation method. The work reported here aimed to highlight transfixing wires as a fixation method for valgus osteotomy applied as treatment for various types of pediatric coxa vara. MATERIALS AND METHODS: This study included 16 cases of pediatric coxa vara with different etiologies in 9 patients with a mean age of 39.9 ± 15.2 months. Radiological and clinical evaluations and scoring of the condition of each patient according to the Iowa Hip Score were performed pre- and postoperatively. Transfixing wires and a protective spica were used for the fixation of a V-shaped, laterally based, closing-wedge valgus osteotomy in all cases. The postoperative follow-up period ranged from 14 to 102 months, with a mean duration of 33.3 ± 27.7 months. RESULTS: The mean Hilgenreiner epiphyseal angle (HEA) was corrected from 81.7 ± 2.2° to 24.3 ± 3.5° and the mean femoral neck–shaft angle (FNSA) was improved from 86.9 ± 4.2° to 138.6 ± 3.5°. No recurrence of the deformity was observed during the follow-up periods considered here. The osteotomy site united after an average of 11.7 ± 2.2 weeks with no secondary displacement, and in cases of developmental coxa vara there was progressive ossification of the neck defect with no surgery-related complications. Clinical results were markedly improved by the osteotomy, with a mean postoperative Iowa Hip Score at last follow-up of 95.06 ± 2.6, compared to a mean preoperative score of 57.4 ± 3.6. CONCLUSIONS: Transfixing wires protected in a hip spica cast represent a simple, easy, and reliable fixation method for valgus osteotomies performed to correct pediatic coxa vara. It assures stable fixation and rapid healing of the osteotomy without loss of the achieved correction, it completely avoids the femoral neck affording marked protection to the growth plate. LEVEL OF EVIDENCE: IV. Springer International Publishing 2017-07-12 2017-12 /pmc/articles/PMC5685981/ /pubmed/28702703 http://dx.doi.org/10.1007/s10195-017-0463-x Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article
Rizk, Ahmed Shawkat
Transfixing Kirshner wires for fixation of intertrochanteric valgus osteotomies in management of pediatric coxa vara
title Transfixing Kirshner wires for fixation of intertrochanteric valgus osteotomies in management of pediatric coxa vara
title_full Transfixing Kirshner wires for fixation of intertrochanteric valgus osteotomies in management of pediatric coxa vara
title_fullStr Transfixing Kirshner wires for fixation of intertrochanteric valgus osteotomies in management of pediatric coxa vara
title_full_unstemmed Transfixing Kirshner wires for fixation of intertrochanteric valgus osteotomies in management of pediatric coxa vara
title_short Transfixing Kirshner wires for fixation of intertrochanteric valgus osteotomies in management of pediatric coxa vara
title_sort transfixing kirshner wires for fixation of intertrochanteric valgus osteotomies in management of pediatric coxa vara
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685981/
https://www.ncbi.nlm.nih.gov/pubmed/28702703
http://dx.doi.org/10.1007/s10195-017-0463-x
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