By David A. Spiegel
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Extra info for Bibliography of Orthopaedic Problems in Developing Countries
A new type of reconstruction operation for old ununited fracture of the neck of the femur. J Bone Joint Surg 17:110-122, 1935. Six cases of greater trochanteric arthroplasty are described for femoral neck nonunion in older patients. The technique involves circumferential muscle release around the trochanter, with care to avoid subperiostial dissection. The neck is debrided to be flush with the femoral shaft, and the trochanter is placed within the acetabulum. The abductors are advanced and sutured to a trough in the lateral aspect of the femur (tensioned at 20 degrees abduction).
The different classes, and their recommended treatment, are as follows: I (5) = No residual deformity, radiographic features of AVN Containment until reossification with an abduction orthosis or cast. IIa (7) = Coxa breva + deformed head treat avascular changes with containment, apophysiodesis or transfer of the greater trochanter for abductor insufficiency, pelvic osteotomy for coverage, epiphysiodesis for LLD. IIb (4) = Progressive coxa vara or valga from asymmetric premature physeal closure partial epiphysiodesis of the femoral physis +/- greater trochanteric apophysis, proximal femoral osteotomy.
The site of transference is distally, above the malleoli. A longitudinal incision is made over the anterior compartment, and the fibular shaft is exposed subperiostially and osteotomized obliquely. The fibula is then brought through a plane between the interosseous membrane and the anterior compartment musculature, and keyed in to a slot in the lateral surface of the tibia. Patients were immobilized in a long leg cast for 3 months, and a walking brace was applied. In those with congenital pseudarthrosis, a walking cast was maintained for at least one year.