Intertrochanteric Osteotomy for AVN
– either a valgus flexion osteotomy
– or a varus osteotomy
– basically, you do whatever is necessary to get the collapsed part of the head (Ficat III) out of the weightbearing zone.
– the results of osteotomy versus vascularized fibular graft for Ficat III are pretty similar.
– for periacetabular osteotomies, the acetabular fragment does rely at leas to some degree on the capsule for its blood supply. The advantage of the Bernese osteotomy over other periacetabular osteotomies is that the ischium is not dissected out completely, so that the blood supply to the acetabulum is felt to be more intact, supplemented by branches of the inferior gluteal artery. You can therefore do a capsulotomy and deal with the intraarticular pathology without worrying as much about the blood supply to the acetabular fragment. Eg. Don’t do a capsulotomy after performing a spherical osteotomy.
Good review of basic principles – use in conjunction with Don’s notes from Rounds.