A Case report: Corrective Osteotomy of Shepherd’s Crook Deformity in Polyostotic Fibrous Dysplasia with Reverse Distal Femoral Locking Plate Fixation

กล มงานออร โธป ดกส โรงพยาบาลพทธชนราช Department of Orthopedics, Buddhachinaraj Phitsanulok Hospital Abstract Fibrous dysplasia is a benign disease but if it causes decrease of the femoral neck shaft angle it can increase the risk of pain and risk of neck-femur fracture in the future. This report assessed a 22-year-old female who presented with pain and limping at her left hip. Radiographs of her left hip revealed shepherd’s crook deformity. Polyostotic fibrous dysplasia disease was diagnosed (left proximal femur and left tibia) by typical radiographic findings (ground glass). Proximal femoral valgus osteotomy was performed to increase femoral neck shaft angle about 10 degrees and fixed with distal femoral locking plate. Bone union was achieved without instrument failure. However, a stress fracture at the distal part of the plate occurred after four postoperative months when the patient walked with full weight bearing force. This required plate revision. This type of osteotomy and fixation gives encouraging results for this bone deformity but practitioners must be aware about the risks of weight bearing activities in order to prevent peri-prosthetic fractures.