Salvage of a failed valgus osteotomy for non-union of an unstable pertrochanteric fracture

Background: Management of fracture non-union of the neck of femur is age specific and is quite demanding. There is a need to salvage the femoral headin younger individuals which demands a procedure which suits the requirements. The aim of this study was to evaluate the role of valgus osteotomy with dynamic hip screw fixation(DHS) in the management of these fractures and to compare the results with studies of other authors as available in literature.Methods: This was a prospective study of 15 patients with fracture nonunion of the femoral neck conducted between January 2012 to January 2013 with a follow up period of 3 years.Results: There were 9 males and 6 female patients in our study with the right side being more commonly affected. The mean age of the patients was 45.2 years ranging from 36 to 58 years. All fractures united at the end of 6 months. Post operatively the mean Pauwels angle was 340 while the neck shaft angle was 135.20. There was a significant increase in the Oxford score from a mean of 20.4 preoperatively to 37.9 in the postoperative period. All patients were happy with the procedure and the functional outcome. Conclusions: Valgus osteotomy with DHS fixation is a good option for the management of fracture nonunion of the neck of femur in younger patients where there is a need to salvage the femoral head and it gives good functional results.

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Non-union of femoral neck fractures with osteonecrosis of the femoral head: treatment with combined free vascularized fibular grafting and subtrochanteric valgus osteotomy

Orthopedic Clinics of North America ◽

10.1016/j.ocl.2004.02.008 ◽

2004 ◽

Vol 35 (3) ◽

pp. 335-343 ◽

Cited By ~ 26

Author(s):

Alexandros E Beris ◽

Alexander H Payatakes ◽

Vassilios K Kostopoulos ◽

Anastasios V Korompilias ◽

Alexandros N Mavrodontidis ◽

...

Keyword(s):

Femoral Head ◽

Femoral Neck ◽

Femoral Neck Fractures ◽

Valgus Osteotomy ◽

Non Union ◽

Fibular Grafting ◽

Free Vascularized Fibular Grafting

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Modified Valgus Osteotomy for Treatment of Femoral Neck Fracture Non-Union

Orthopedic & Muscular System ◽

10.4172/2161-0533.1000110 ◽

2012 ◽

Vol 01 (03) ◽

Author(s):

Babak Siavashi ◽

Mohammad Reza Golbakhsh ◽

Dariush Gouran Savadkoohi

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Valgus Osteotomy ◽

Non Union ◽

Neck Fracture

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Role of Valgus Osteotomy and Fixation with Double Angle Blade Plate in the Management of Neglected and Ununited Femoral Neck Fracture

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/44597.15169 ◽

2021 ◽

Author(s):

Hari Om Aggarwal ◽

Amandeep Singh Bakshi ◽

Harjit K Singh Chawla ◽

Ayush Jain ◽

Jaspreet Singh

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Young Patients ◽

Valgus Osteotomy ◽

Non Union ◽

Neck Shaft Angle ◽

Blade Plate ◽

Neck Fracture ◽

Angle Blade ◽

Angle Blade Plate

Introduction: Femoral neck fracture non union in young patients is a challenging complication as joint replacement is not readily recommended and hip salvageable procedures are relatively unsatisfactory. Valgus intertrochanteric osteotomy described by Pauwels F is one of the treatment options for management of non union of femoral neck in young patients, which was later reciprocated by other surgeons. Aim: To assess the efficacy of valgus osteotomy and fixation with double angle blade plate in the management of neglected and ununited femoral neck fracture. Materials and Methods: This was a prospective cohort study, which included 30 patients of femoral neck fracture non union in whom intertrochanteric valgus osteotomy was performed and fixed with 120° double angled blade plate. The preoperative and postoperative neck-shaft angle was compared using the paired t-test. A p-value of <0.05 indicated statistically significant result. Results: There were 22 males (73.3%) and 8 females (26.7%). Mean age of patients was 35 years. Delay in presentation ranged from 8 weeks to 58 weeks (mean 24 weeks). By Pauwel’s classification, there were 13 Type II fractures and 17 Type III fractures. Mean follow- up was 18 months (12 to 36 months). The mean preoperative neck- shaft angle of 95° (range 80-110°) increased to 132° (range 120- 140°) after surgery. In all patients, there was improvement in leg length discrepancy after osteotomy. Femoral neck fractures united in 25 patients (83.3%). Conclusion: Valgus osteotomy and fixation with 120° double angle blade plate is a reliable method for treating non union femoral neck fracture in young adults. It provides rigid internal fixation and good results.

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Closing lateral wedge valgus osteotomy with dynamic hip screw for the treatment of varus nonunion of pertrochanteric fracture: can restoration of biomechanics and stabilization alone heal?

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-008-0791-7 ◽

2008 ◽

Vol 129 (6) ◽

pp. 827-832 ◽

Cited By ~ 4

Author(s):

S. Vidyadhara ◽

Sharath K. Rao ◽

S. Pandian ◽

James Gnanadoss

Keyword(s):

Dynamic Hip Screw ◽

Pertrochanteric Fracture ◽

Valgus Osteotomy ◽

Hip Screw

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Functional and radiological outcome of valgus osteotomy (abduction osteotomy of Pauwel) and fixation with dynamic hip screw in neglected fracture neck of femur

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20203504 ◽

2020 ◽

Vol 6 (5) ◽

pp. 920

Author(s):

Venugopal S. M. ◽

Naveen Babu ◽

Naresh Odnala ◽

Gudaru Jagadesh

Keyword(s):

Femoral Neck ◽

Young Patients ◽

Dynamic Hip Screw ◽

Harris Hip Score ◽

Osteotomy Site ◽

Valgus Osteotomy ◽

Neck Of Femur ◽

Non Union ◽

Fracture Neck Of Femur ◽

Hip Screw

Background: Despite improvements in the techniques of surgery and internal fixation devices, non-union is still reported in one-third of cases of femoral neck fracture with displacement. Valgus intertrochanteric osteotomy alters the biomechanical environment of the fracture site and restores limb length.Methods: This was a prospective study on functional outcome of valgus osteotomy and fixation with dynamic hip screw (DHS) in neglected fracture neck of femur in Balaji Institute of Surgery, Research and Rehabilitation for the Disabled (BIRRD), Tirupati. 28 patients were enrolled between December 2017 to December 2019. Patients less than 60 years of age with fracture neck of femur of more than or equal to 3 weeks since injury and with failed primary fixation were included. Patients >60 years of age, patients with avascular necrosis (AVN), and with resorption of femoral neck were excluded.Results: Among 28 patients 12 had union within 6 months and another 12 within 12 months. 4 patients were lost for follow-up hence considered as non-union. Osteotomy site united by 6 months in 22 patients and by 12 months in 2. Harris hip score was fair to excellent in 24 patients and poor in 4.Conclusions: Valgus osteotomy and DHS fixation is often a definitive one-time surgical procedure to achieve union in neglected and ununited fracture neck femur in young patients. It is simple and biological. In this study because of the delay in presentation and the young age of patients, Pauwels’ osteotomy was performed as the head-salvaging procedure. Union was achieved in 86% of this study patients.

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A Complicated Stress Fracture of the Femoral Neck - A Case Report

Journal of The Royal Naval Medical Service ◽

10.1136/jrnms-89-5 ◽

2003 ◽

Vol 89 (1) ◽

pp. 5-8

Author(s):

G Selzer ◽

R A Ross ◽

T J W Spalding

Keyword(s):

Case Report ◽

Femoral Neck ◽

Operative Treatment ◽

Stress Fracture ◽

Revision Surgery ◽

Young Patients ◽

Valgus Osteotomy ◽

Non Union ◽

Complete Fracture

AbstractA case is presented of a stress fracture of the femoral neck complicated by complete fracture. Additional complications arose when the repaired fracture went on to non-union due to bending of the DHS screw, requiring revision surgery with a valgus osteotomy. The case is important because this type of stress fracture has previously been considered to be safe from risk of complete fracture. The failure of the operative treatment has implications for young patients treated similarly.

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