Changing Pattern of Femoral Deformity During Growth in Polyostotic Fibrous Dysplasia of the Bone: An Analysis of 46 Cases.

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Abstract

[Indexed for MEDLINE] 19. Am J Case Rep. 2025 Nov 10;26:e949433. doi: 10.12659/AJCR.949433. Preoperative Virtual Planning Combined with 3D-Printed Surgical Guide Technology for Correction of Shepherd's Crook Deformity: A Case Report. Wu J(1), Zhu H(2), Shang B(1), Liang J(1), Long Y(3), Ding H(1)(2), Yan H(1). Author information: (1)Guangzhou First People's Hospital, Guangzhou, Guangdong, China. (2)School of Medicine, South China University of Technology, Guangzhou, Guangdong, China. (3)The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China. BACKGROUND Shepherd's crook deformity, a rare and severe skeletal malformation, is characterized by a distinctive shepherd's crook-like curvature of the proximal femur. This pathological condition manifests as a marked reduction in the femoral neck-shaft angle (typically measuring less than 90 degrees). The deformity is most frequently observed in patients with fibrous dysplasia (FD), where it is a hallmark skeletal manifestation of the disease. CASE REPORT A 12-year-old boy presented with progressive deformity of both lower limbs. Physical examination revealed a typical "shepherd's crook" deformity of both femurs with associated abnormalities of the left tibia and fibula. Radiographic findings confirmed polyostotic fibrous dysplasia affecting multiple bones and causing severe lower-limb malalignment. Preoperative three-dimensional (3D) CT reconstruction and digital planning were performed to design an individualized osteotomy, and a patient-specific surgical guide was fabricated to ensure accuracy. Postoperative imaging demonstrated restoration of anatomical axes and improved mechanical alignment. Measurements showed a right femoral neck-shaft angle of 125.7°, a left angle of 129.1°, and a residual limb length discrepancy of 9 mm. The patient recovered well without complications. CONCLUSIONS This case report demonstrates the integration of preoperative virtual surgical planning with 3D-printed patient-specific guides for precise correction of femoral shepherd's crook deformity, exemplifying the clinical application of digital orthopedic technologies in complex skeletal reconstruction. DOI: 10.12659/AJCR.949433 PMCID: PMC12684040