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
Satya Prakash Singh1, Yashwant Tanwar1, Atin Jaiswal2, Masood Habib1,
1 Department of Orthopaedics, PGIMER, Dr. RML Hospital, New Delhi, India
2 Department of Orthopaedics, Bokaro General Hospital, Bokaro, Jharkhand, India
Satya Prakash Singh
Room No. 302, Dr. Hostel, Dr. RML Hospital, New Delhi - 110 001
|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;48:343-344
|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 2020 Jan 24 ];48:343-344
Available from: http://www.ijoonline.com/text.asp?2014/48/3/343/132538
We read the article by Sen et al.  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.  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.  reported that femoral neck shortening had a negative impact on the SF-36 score. Similarly, Boraiah et al.  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.
|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.|
|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.|
|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.|
|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.|