Neurobionplus
Home About Journal AHEAD OF PRINT Current Issue Back Issues Instructions Submission Search Subscribe Blog    
Login 

Users Online: 430 
Print this page  Email this page Small font sizeDefault font sizeIncrease font size 
 


 
 Table of Contents    
LETTER TO EDITOR  
Year : 2014  |  Volume : 48  |  Issue : 3  |  Page : 343-344
Modified valgus osteotomy of the femoral neck for late presenting femoral neck stress fractures in military recruits


1 Department of Orthopaedics, PGIMER, Dr. RML Hospital, New Delhi, India
2 Department of Orthopaedics, Bokaro General Hospital, Bokaro, Jharkhand, India

Click here for correspondence address and email

Date of Web Publication14-May-2014
 

How to cite this article:
Singh SP, Tanwar Y, Jaiswal A, Habib M. Modified valgus osteotomy of the femoral neck for late presenting femoral neck stress fractures in military recruits. Indian J Orthop 2014;48:343-4

How to cite this URL:
Singh SP, Tanwar Y, Jaiswal A, Habib M. Modified valgus osteotomy of the femoral neck for late presenting femoral neck stress fractures in military recruits. Indian J Orthop [serial online] 2014 [cited 2019 Oct 19];48:343-4. Available from: http://www.ijoonline.com/text.asp?2014/48/3/343/132538
Sir,

We read the article by Sen et al. [1] with great interest. The authors have done modified valgus osteotomy of femoral neck for displaced tensile stress fracture in an adult with good result. However, we have a few concerns.

The authors have taken care to see that they do not disturb the posterior capsule and, so, the medial circumflex artery. But posterior capsule is naturally preserved because capsule is deficient posteriorly at the lateral third of neck; more so, the osteotomy site is toward trochanteric fossa, so it is totally protected. But my concern is about lateral ascending artery which traverses the capsule at posterior trochanteric fossa and is present exactly at the osteotomy site. This is a major blood supply to the femoral head, neck, and to the trochanter in the adult. [2] We would like to know how the authors managed it.

This study states that osteotomy leads to shortening of femoral neck and the abductor lever arm, resulting in diminished efficiency of abductors, which is clearly evident in the figures in the article. Many studies have evaluated the importance of femoral neck length influencing the functional outcome. Zlowodzki et al. [3] reported that femoral neck shortening had a negative impact on the SF-36 score. Similarly, Boraiah et al. [4] reported that bodily pain subscore of the SF-36 correlated with the "abductor lever arm." So, how will the authors justify changing the anatomy of proximal femur and its biomechanics?

The authors have stressed about inferomedial osteoperiosteal hinge to maintain the continuity of bony trabeculae which has an important role in union. We would like to know how the authors managed to maintain the trabeculae in partially displaced varus fracture, that too, after the abduction osteotomy and multiple bone drilling.

 
   References Top

1.Sen RK, Tripathy SK, Manoharan SR, Chakrabarthy S. Modofied valgus osteotomy of the femoral neck for late presenting stress fracture in military recruits. Indian J Orthop 2013;47:510-4.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Wertheimer LG, Lopes Sde L. Arterial supply of the femoral head. A combined angiographic and histological study. J Bone Joint Surg 1971;53A: 545-56.  Back to cited text no. 2
    
3.Zlowodzki M, Ayieni O, Petrisor BA, Bhandari M. Femoral neck shortening after fracture fixation with multiple cancellous screw: Incidence and effect on function. J Trauma 2008;64:163-9.  Back to cited text no. 3
    
4.Boraiah S, Paul O, Hammond S, Gardner MJ, Helfet DL, Lorich DG. Predictable healing of femoral neck fracture treated with intraoperative compression and length-stable implant. J Trauma 2010;69:142-7.  Back to cited text no. 4
    

Top
Correspondence Address:
Satya Prakash Singh
Room No. 302, Dr. Hostel, Dr. RML Hospital, New Delhi - 110 001
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5413.132538

Rights and Permissions




 

Top
 
 
 
  Search
 
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    References
 

 Article Access Statistics
    Viewed932    
    Printed24    
    Emailed0    
    PDF Downloaded87    
    Comments [Add]    

Recommend this journal