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Bone Joint J. 2015 Jan;97-B(1):24-8. doi: 10.1302/0301-620X.97B1.34525.

The incidence of stress fracture following peri-acetabular osteotomy: an under-reported complication.

Author information

1
Northumbria Healthcare NHS Foundation Trust, Wansbeck General Hospital, Woodhorn Lane, Ashington, NE63 9JJ, UK.
2
Guy's and St Thomas' Hospital, London, 1st Floor, Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK.
3
Southampton University Hospitals NHS Trust, Tremona Road, Southampton SO16 6YD, UK.
4
University College of London Hospitals, 235 Euston Road, London NW1 2BU, UK.

Abstract

Stress fractures occurring in the pubis and ischium after peri-acetabular osteotomy (PAO) are not well recognised, with a reported incidence of 2% to 3%. The purpose of this study was to analyse the incidence of stress fracture after Bernese PAO under the care of two high-volume surgeons. The study included 359 patients (48 men, 311 women) operated on at a mean age of 31.1 years (15 to 56), with a mean follow-up of 26 months (6 to 64). Complete follow-up radiographs were available for 348 patients, 64 of whom (18.4%) developed a stress fracture of the inferior pubic ramus, which was noted at a mean of 9.1 weeks (5 to 55) after surgery. Most (58; 91%) healed. In 40 of the patients with a stress fracture (62.5%), pubic nonunion also occurred. Those with a stress fracture were significantly older (mean 33.9 years (16 to 50) vs 30.5 years (15 to 56), p = 0.002) and had significantly more mean pre-operative deformity: mean centre-edge angle (9.8° (-9.5 to 35) vs 12.4° (-33 to 28), p = 0.04) and mean Tönnis angle (22.8° (0 to 45) vs 18.7° (-2 to 38), p < 0.001). The pubic nonunion rate was significantly higher in those with a stress fracture (62.5% vs 7%, p < 0.001), with regression analysis revealing that these patients had 11.8 times higher risk than those without nonunion.

KEYWORDS:

Peri-acetabular osteotomy; Stress fracture; Complication

PMID:
25568409
DOI:
10.1302/0301-620X.97B1.34525
[Indexed for MEDLINE]

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