Stepped osteotomy of the trochanter for stable, anatomic refixation

Bastian, Johannes D.; Wolf, AT; Wyss, TF; Nötzli, HP (2009). Stepped osteotomy of the trochanter for stable, anatomic refixation. Clinical orthopaedics and related research, 467(3), pp. 732-8. Heidelberg: Springer 10.1007/s11999-008-0649-x

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Refixation of a trochanteric osteotomy carries a high complication rate. To enhance stability and facilitate anatomic reduction of the trochanteric fragment, we have introduced a stepped osteotomy. Between April 2006 and June 2007, we performed surgical hip dislocations using the modified trochanteric osteotomy combined with a relatively aggressive rehabilitation program. Full weightbearing was allowed at a mean of 42 days (range, 33-54 days). The minimum followup was 8 months (median, 13 months; range, 8-24 months). Postoperative radiographs were assessed prospectively for consolidation or the appearance of malreduction/nonunion/malunion of the osteotomy and heterotopic ossification. In 110 of 113 hips, the trochanteric osteotomy healed in the anatomic position. Two patients had a trochanteric delayed union with loss of anatomic position, and one additional patient underwent revision surgery for a pseudarthrosis and cranial migration of the trochanteric fragment. All three complications related to healing occurred in the first 60 patients when the step height was 3 to 4 mm. After increasing the step heights to 6 mm, we observed no healing complications. Despite more aggressive postoperative mobilization, the incidence of malunion or nonunion related to the new stepped osteotomy is low and approaches zero for steps of 6 mm. It is now our technique of choice.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery

UniBE Contributor:

Bastian, Johannes Dominik

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0009-921X

ISBN:

19067094

Publisher:

Springer

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 15:09

Last Modified:

25 Jul 2014 13:39

Publisher DOI:

10.1007/s11999-008-0649-x

PubMed ID:

19067094

Web of Science ID:

000263070900018

URI:

https://boris.unibe.ch/id/eprint/30274 (FactScience: 191674)

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