Multiple valgus osteotomies combined with intramedullary nail for shepherd’s crook deformity in polyostotic fibrous dysplasia: a case series and review of the literature

The aim of this study was to investigate the long-term clinical outcomes of valgus osteotomy combined with intramedullary nail for the treatment of shepherd’s crook deformity of polyostotic fibrous dysplasia. We reviewed the clinical data of 22 patients with polyostotic fibrous dysplasia that was treated at our department between January 1995 and January 2010. All 22 of the patients (23 femurs) had shepherd’s crook deformity. We performed a sequence of 3 procedures to treat shepherd’s crook deformity: valgus osteotomy, massive impaction allograft with deep-frozen allogeneic cortical bone, and insertion of an intramedullary nail with neck cross pins. The mean follow-up time was 97 (range 60-155) months. The neck-shaft angle was corrected from a mean value of 75° (range 45°-100°) preoperatively to a mean value of 125° (range 95°-140°) postoperatively. The mean extremity lengthening was 28 mm (range 18-45 mm). Almost all of the osteotomy sites healed within 6 months postoperatively. The alignments of all of the 23 femurs were restored to normal. There was no recurrent fracture or deformity progression after a mean follow-up of 8 years. Valgus osteotomy can correct shepherd’s crook deformity, restore the alignment of the femur, and restore the neck-shaft angle. The impaction allograft can provide enough initial stability for the intramedullary nail to help the union of the osteotomy site. The intramedullary nail with neck cross pins can maintain the corrected alignment of the femur and prevent both recurrent pathological fracture and progression of the deformity.