Management of Old Neck Femur Fracture through Valgus Osteotomy and Pin Fixation

Introduction: Valgus intertrochanteric osteotomy alters the biomechanical environment of thefracture site and restores limb length. Very few reports have dealt with the results of this procedureinternally fixed with a dynamic hip screw and double angle barrel plate. Hence, the prospectivestudy was performed at the institution level for the evaluation of results of valgus osteotomy andfixation of the femur neck fracture in young patients. Material and Methods: A total of 32 patientswere included in the study. There were 24 males and 8 females in the study. Before osteotomy, theaverage neck-shaft angle was 101° (80–120°), with an average limb shortening of 2.3cm (1.0–3.2cm). The greater trochanter was up riding in fourteen cases and needed skeletal traction beforesurgery. None of these had evidence of vascular necrosis on plain radiograph or MRI. The fractureswere treated with a dynamic hip screw and double angle barrel plate. The patients had a minimumfollow-up of 14months and a maximum of 42months. Results: In a total of 28 patients the excellentresults were obtained, however in 4 patients the poor result was due to cut – out of implants. Noneof the patients were lost on follow up, the fracture went on to achieve the satisfactory union afterthe minimum of 14 weeks follows up. The average preoperative neck-shaft angle of 101° (range 80–120°) increased to 134° (range 120–145°) after surgery. The average limb length discrepancypostoperatively was 2.3cm. Conclusion: From the study, it was concluded that valgus osteotomyand fixation with dynamic hip screw and 120° double angle barrel plate has a high success rate inyoung patients with neglected and ununited intracapsular fracture neck of the femur as far as theunion of fracture is concerned.

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Role of valgus osteotomy and fixation with dynamic hip screw and 120° double angle barrel plate in the management of neglected and ununited femoral neck fracture in young patients

Journal of Orthopaedics and Traumatology ◽

10.1007/s10195-009-0049-3 ◽

2009 ◽

Vol 10 (2) ◽

pp. 71-78 ◽

Cited By ~ 15

Author(s):

Abdul Qayyum Khan ◽

Mohammad Shahnawaz Khan ◽

Mohammed Khalid Anwar Sherwani ◽

Rahul Agarwal

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Young Patients ◽

Dynamic Hip Screw ◽

Valgus Osteotomy ◽

Neck Fracture ◽

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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Valgus Osteotomy and Repositioning and Fixation with a Dynamic Hip Screw and a 135° Single-Angled Barrel Plate for Un-United and Neglected Femoral Neck Fractures

Journal of Orthopaedic Surgery ◽

10.1177/230949901402200106 ◽

2014 ◽

Vol 22 (1) ◽

pp. 13-17 ◽

Cited By ~ 7

Author(s):

Sameer Gupta ◽

Sunil Kukreja ◽

Vivek Singh

Keyword(s):

Femoral Neck ◽

Femoral Neck Fractures ◽

Dynamic Hip Screw ◽

Valgus Osteotomy ◽

Hip Screw

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Accuracy of valgus osteotomy using dynamic hip screw

Injury ◽

10.1016/s0020-1383(17)30486-2 ◽

2017 ◽

Vol 48 ◽

pp. S2-S7 ◽

Cited By ~ 1

Author(s):

Sunil G. Kulkarni ◽

G.S. Kulkarni ◽

Sushrut Babhulkar ◽

Milind G. Kulkarni ◽

Ruta M. Kulkarni

Keyword(s):

Dynamic Hip Screw ◽

Valgus Osteotomy ◽

Hip Screw

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Randomized control trial comparing the functional outcomes of dynamic hip screw and locking plate dynamic hip screw in intertrochanteric fractures of femur

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20201090 ◽

2020 ◽

Vol 6 (3) ◽

pp. 525

Author(s):

Kiran Ramachandran ◽

Dileep Sasidharan ◽

Oommen Mathew

Keyword(s):

Functional Outcomes ◽

Locking Plate ◽

Dynamic Hip Screw ◽

Research Centre ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Neck Shaft Angle ◽

Operative Care ◽

Significant Difference ◽

Hip Screw

Background: The objective of the study was to compare the functional outcomes of intertrochanteric fractures of the femur treated with dynamic hip screw (DHS) and locking plate DHS in elderly.Methods: 48 participants (23 in DHS and 25 in locking plate DHS) aged ≥ 50 years with intertrochanteric fracture of femur were enrolled in the present randomized open label parallel group trial conducted at Pushpagiri Institute of Medical Sciences and Research Centre during a period of 1 year. Open, pathological, other fractures in the same limb and participants with neurological involvement were excluded. Standard of care (pre and post-operative care) was given to all participants. Sociodemographic, radiological findings, fracture type and Singh’s index were recorded at baseline, 6 weeks, 3 and 6 months. Study commenced after approval from Institutional Ethics Committee and written informed consent was obtained from all study participants. Participants were randomized in 1:1 ratio using coin flip method. Quantitative variables were expressed means and medians and qualitative variables were expressed as proportions. Tests of significance were independent sample t test, Mann Whitney U test, Friedman test and Chi square test.Results: Between DHS and locking plate DHS, no significant difference in baseline parameters, neck shaft angle, tip apex distance, shortening, Harris hip score, range of motion score and length of hospital stay were observed.Conclusions: The functional outcomes and complications between DHS and locking plate DHS were not significantly different.

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Valgus Osteotomy Outcome for Treating Femoral Neck Nonunion in Young and Active Patients

Journal of Research in Orthopedic Science ◽

10.32598/jrosj.8.2.400.1 ◽

2021 ◽

Vol 8 (2) ◽

pp. 65-70

Author(s):

Kaveh Gharanizadeh ◽

◽

Hamed Tayyebi ◽

Abbas Esmaeli ◽

Maziar Rajei ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Femoral Neck ◽

Hip Arthroplasty ◽

Limb Length Discrepancy ◽

Osteotomy Site ◽

Valgus Osteotomy ◽

Neck Shaft Angle ◽

Shaft Angle ◽

The Mean

Background: Femoral neck fracture nonunion is a frequent and challenging complication, with several surgical options. Objectives: The present study reported the outcome of valgus osteotomy for treating femoral neck nonunion in patients aged <65 years. Methods: This case series research included young patients who underwent valgus osteotomy for treating femoral neck nonunion or device failure of the index surgery. The fixation of the osteotomy site was performed using either a dynamic hip screw or a fixed angle blade. The union of the neck and osteotomy site (subtrochanteric region) was evaluated by monitoring callus formation in the postoperative radiographs. Limb length discrepancy, Pauwels’ angle, and the neck-shaft angle were evaluated before the surgery and at the last follow-up. Postoperative complications were extracted from the explored patients’ profiles. Results: Twenty patients with a Mean±SD age of 27.2±10.8 years were examined in this study‎. The Mean±SD follow-up time of the patients was 6.1±3.9 years. The femoral neck was united in 18 patients in a Mean±SD period of 5.1±2.3 months. The Mean±SD limb length discrepancy was measured as 1.3±0.8 cm before and 0.5±0.7 cm after the ‏osteotomy. The Mean±SD Pauwels’ angle was calculated as 65.5±16.9º before and 32.4±16.2º after the osteotomy. The Mean±SD neck-shaft angle was computed to be 121.9±22.8º before and 144.5±17.7º after the osteotomy. Revision surgery was performed for 6 (30%) patients. This measure included device removal in 4 and total hip arthroplasty in 2 patient. Conclusion: Valgus osteotomy is a safe and efficient technique for managing femoral neck nonunion. Therefore‎, this approach is suggested as a good alternative for total hip arthroplasty, particularly in young and active patients‎.

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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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A study of an operative outcome of a basitrochanteric fractures of the hip treated by dynamic hip screw and enders nail with percutaneous canulated cancellous screw

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20195815 ◽

2019 ◽

Vol 6 (1) ◽

pp. 198

Author(s):

Ambrish J. Vyas ◽

Vijay J. Patel ◽

Keval H. Patel ◽

Ravi G. Panchal

Keyword(s):

Plain Radiograph ◽

High Energy ◽

Fracture Pattern ◽

Dynamic Hip Screw ◽

Fracture Geometry ◽

Excellent Outcome ◽

Stable Variety ◽

Implant Selection ◽

Hip Screw

Background: Basicervical or cervicotrochanteric fracture of the femur is considered stable variety of fracture pattern. Most common incidence is seen in elderly patient and in young patient with probably high energy trauma. Appropriate Osteosynthesis confers excellent outcome when reduction is optimally achieved.Methods: 86 basitrochanteric fractures had been treated with enders nail or dynamic hip screw (DHS) at our institute by a single surgeon. Implant selection was done purely based on plain radiograph, associated co-morbidities and fracture geometry. Patients had been followed up at 1 month, 3 month and 6 month.Results: In our study there were 86 patients out of which 63 patients (73.25%) were treated with enders nail and 23 patients (26.74%) were treated with DHS. Mean age of patients was 57 years. We noted minimum follow up of 8 months while maximum follow up of 4.5 years where as mean follow up duration is 18 months. We almost noted excellent to fair results in both groups.Conclusions: Most of the implants in basitrochanteric fractures worked on control collapse principle. Both DHS and enders nail with percutaneous cc screw follow this principle and when used with a proper technique, optimal reduction usually fetch the favourable outcomes with minimalistic approach.

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