title: Stepped osteotomy of the trochanter for stable, anatomic refixation.
abstract: 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.
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Spital Netz Bern-Ziegler, Morillonstrasse 75-91, 3001, Bern, Switzerland.
authors.forename: Johannes D
authors.initials: JD
authors.lastname: Bastian
authors.forename: Alexandra T
authors.initials: AT
authors.lastname: Wolf
authors.forename: Tobias F
authors.initials: TF
authors.lastname: Wyss
authors.forename: Hubert P
authors.initials: HP
authors.lastname: Nötzli
mesh_terms: D000077:Acetabulum / Q000000981:diagnostic imaging / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007592:Joint Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016348:Osseointegration; D009999:Ossification, Heterotopic / Q000209:etiology; D010027:Osteotomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D011542:Pseudarthrosis / Q000209:etiology; D011859:Radiography; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult