Shepherd's crook deformity: How to set it straight. A five-step surgical guide

Area of Science:

• Orthopedic surgery
• Bone pathology

Background:

• Fibrous dysplasia (FD) of the proximal femur often leads to significant deformity and disability.
• Previous surgical interventions for proximal femur FD have yielded suboptimal results.

Observation:

• A prospective review of three patients (four femora) with polyostotic proximal femur FD managed from 2012 onward.
• Patients underwent a standardized five-step surgical procedure: lesion curettage/excision, allograft insertion, valgus osteotomy, extramedullary fixation, and autograft augmentation.

Findings:

• The five-step technique demonstrated significant correction of the neck shaft angle (91.7° to 152.1°).
• Functional outcomes, measured by the Harris Hip Score, improved substantially from an average of 59 to 95.
• No recurrence of disease or deformity was observed clinically or radiologically during the follow-up period.

Implications:

• This novel five-step surgical technique provides excellent functional and radiological outcomes for proximal femur FD.
• The described method offers a reliable treatment option for complex cases of fibrous dysplasia affecting the proximal femur.