Evidence map›Paper›PMID 40728642›Full record

ArticleInternational orthopaedics2025

One-stage surgical correction of Shepherd's crook deformity in fibrous dysplasia using fibular strut allograft augmentation: a retrospective case-series.

Khodamorad Jamshidi, Abolfazl Bagherifard, Amin Hamidzadah Khiavi, Alireza Mirzaei

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Article in International orthopaedics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 authors.

Khodamorad JamshidiBone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Abolfazl BagherifardBone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Amin Hamidzadah KhiaviBone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Alireza MirzaeiBone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. mirzaeialireza26@gmail.com.

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6 · The paper itself

Abstract

purposeShepherd's crook deformity is a characteristic complication of fibrous dysplasia (FD) of the femur, leading to coxa vara and mechanical instability. Two-stage surgical approaches involve initial valgus osteotomy followed by delayed intramedullary femoral stabilization, prolonged treatment, and increasing morbidity. This study evaluates a one-stage surgical correction that employs fibular strut allograft augmentation for both the femoral neck and shaft.

methodsA retrospective review was performed on 17 patients with Shepherd's crook deformity who underwent one-stage hip lag screw and side plate fixation with fibular strut allograft augmentation of the femoral neck and shaft between 2002 and 2022. Radiographic and clinical outcomes were assessed, including neck-shaft angle (NSA) restoration, fixation stability, graft incorporation, and functional improvement. The median follow-up of the patients was 96 months.

resultsThe mean preoperative NSA was 93° (SD: 13.5°), improving significantly to 130° (SD: 5°) at the latest follow-up (p < 0.001). Stable fixation was achieved in 16 of 17 patients, with one case of fixation failure. Fibular graft resorption was noted in six patients but did not compromise fixation. Clinically, postoperative pain, limping, and activity limitations improved substantially, though seven patients experienced persistent restrictions in outdoor activities. The average limb shortening was 3.5 cm before the operation and 0.9 cm at the end of the follow-up.

conclusionOne-stage correction of Shepherd's crook deformity using lag hip screw fixation and fibular strut allograft augmentation could be a viable alternative to staged procedures, though further studies are needed to confirm its efficacy and generalizability.

Indexed as

Bone TransplantationFemurFibrous Dysplasia of BoneFibulaAdolescentAdultAllograftsBone PlatesBone ScrewsChildFemaleFemur NeckHumansMaleMiddle AgedOsteotomyFibrous dysplasiaFibular strut allograftShepherd’s crook deformity

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.