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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.

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


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.


Peri-acetabular osteotomy; Stress fracture; Complication

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