Ischiofemoral impingement secondary to valgus intertrochanteric osteotomy: a case report

We report an unusual case of ischiofemoral impingement secondary to valgus intertrochanteric osteotomy. The osteotomy was performed for treatment of epiphysiolysis of the left femoral head.

Keywords:
Femoroacetabular impingement; Ischium; Femur; Osteotomy; Hip

Authorship

Alice Duarte de Carvalho

Fellow in Musculoskeletal Radiology, Radiology Division, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil.University of São PauloBrazilRibeirão Preto, SP, BrazilFellow in Musculoskeletal Radiology, Radiology Division, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil.

Flávio Luís Garcia

Associate Professor, Department of Biomechanics, Medicine, and Rehabilitation of the Locomotor System, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.University of São PauloBrazilRibeirão Preto, SP, BrazilAssociate Professor, Department of Biomechanics, Medicine, and Rehabilitation of the Locomotor System, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.

Marcello Henrique Nogueira-Barbosa Mailing address: Dr. Marcello H. Nogueira-Barbosa. Departamento de Clínica Médica, Divisão de Radiologia – FMRP-USP. Avenida Bandeirantes, 3900, Monte Alegre. Ribeirão Preto, SP, Brazil, 14048-900. E-mail: marcello@fmrp.usp.br.

Associate Professor, Division of Radiology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil.University of São PauloBrazilRibeirão Preto, SP, BrazilAssociate Professor, Division of Radiology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil.

Mailing address: Dr. Marcello H. Nogueira-Barbosa. Departamento de Clínica Médica, Divisão de Radiologia – FMRP-USP. Avenida Bandeirantes, 3900, Monte Alegre. Ribeirão Preto, SP, Brazil, 14048-900. E-mail: marcello@fmrp.usp.br.

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (4)

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Figure 1
A: Initial radiograph of the left hip, in an anteroposterior view, showing signs of epiphysiolysis, with inferomedial displacement of the femoral head and an open physis (arrows). B: Radiograph of the left hip, in an anteroposterior view, after valgus intertrochanteric osteotomy; note the positioning of the osteotomy (arrows), fixed with plates and screws.

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Figure 2
A: Radiograph of the left hip, in an anteroposterior view, approximately one year after valgus intertrochanteric osteotomy, showing signs of early hip osteoarthritis and a reduction in the distance between the lesser trochanter of the femur and the ischial tuberosity. B: Radiograph of the left hip, in an anteroposterior view, approximately 30 years after the initial procedure, showing exacerbation of the previous findings, with progression of hip osteoarthritis and narrowing of the ischiofemoral space (arrows).

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Figure 3
A: Computed tomography slice in the axial plane, with a soft tissue window, showing a reduction in the distance between the lesser trochanter and the left ischium, with signs of reactive hyperostosis and volume loss with fat replacement in the quadratus femoris muscle (arrow). B: Same slice shown in A, although with a bone window.

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Figure 4
A: Contrast-enhanced T1-weighted magnetic resonance imaging scan with fat suppression, showing narrowing of the ischiofemoral space and enhancement of the soft tissues in the quadratus femoris muscle region (arrow). B: Axial T2-weighted sequence with fat suppression, showing a pattern of soft-tissue edema interposed between the minor trochanter and the ischial tuberosity (arrow).

Figure 1 A: Initial radiograph of the left hip, in an anteroposterior view, showing signs of epiphysiolysis, with inferomedial displacement of the femoral head and an open physis (arrows). B: Radiograph of the left hip, in an anteroposterior view, after valgus intertrochanteric osteotomy; note the positioning of the osteotomy (arrows), fixed with plates and screws.

Figure 2 A: Radiograph of the left hip, in an anteroposterior view, approximately one year after valgus intertrochanteric osteotomy, showing signs of early hip osteoarthritis and a reduction in the distance between the lesser trochanter of the femur and the ischial tuberosity. B: Radiograph of the left hip, in an anteroposterior view, approximately 30 years after the initial procedure, showing exacerbation of the previous findings, with progression of hip osteoarthritis and narrowing of the ischiofemoral space (arrows).

Figure 3 A: Computed tomography slice in the axial plane, with a soft tissue window, showing a reduction in the distance between the lesser trochanter and the left ischium, with signs of reactive hyperostosis and volume loss with fat replacement in the quadratus femoris muscle (arrow). B: Same slice shown in A, although with a bone window.

Figure 4 A: Contrast-enhanced T1-weighted magnetic resonance imaging scan with fat suppression, showing narrowing of the ischiofemoral space and enhancement of the soft tissues in the quadratus femoris muscle region (arrow). B: Axial T2-weighted sequence with fat suppression, showing a pattern of soft-tissue edema interposed between the minor trochanter and the ischial tuberosity (arrow).

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Ischiofemoral impingement secondary to valgus intertrochanteric osteotomy: a case report

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[1] Mailing address: Dr. Marcello H. Nogueira-Barbosa. Departamento de Clínica Médica, Divisão de Radiologia – FMRP-USP. Avenida Bandeirantes, 3900, Monte Alegre. Ribeirão Preto, SP, Brazil, 14048-900. E-mail: marcello@fmrp.usp.br.