The incidence of stress fracture following peri-acetabular osteotomy: an under-reported complication
2015
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 Tonnis 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. Cite this article: Bone Joint J 2015; 97-B:24–8.
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