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

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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 &gt;60 years of age, patients with avascular necrosis (AVN), and with resorption of femoral neck were excluded.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>

scholarly journals A Convenient Way to do Valgus Osteotomy for Neglected Fracture Neck of Femur

2015 ◽  
Vol 11 (2) ◽  
pp. 147-151
Author(s):  
P Bansal ◽  
V Singhal ◽  
H Lal ◽  
D Mittal ◽  
RK Arya
Keyword(s):  
Young Adults ◽  
Successful Outcome ◽  
Harris Hip Score ◽  
Wedge Osteotomy ◽  
Valgus Osteotomy ◽  
Neck Of Femur ◽  
Fracture Neck Of Femur ◽  
Hip Screw ◽  
Prospective Longitudinal

Background Neglected fracture of neck of femur in young adults is a major problem in developing countries. Existing treatment options varies from osteotomy to various graft techniques (muscle pedicle, vascularized and nonvascularized fibula etc.). There is paucity of literature regarding the use of double angle barrel plate and hip screw in such cases. We conducted a prospective longitudinal observational study with displaced, neglected fracture neck of femur in young adults and compared the results with literature. Objectives The aim of this study was to determine feasibility and effectiveness of 120° double angle barrel plate and hip screw fixation in neglected fracture neck of femur. Effectiveness of fixed 30 degree closed wedge osteotomy in neglected fracture neck of femur. Methods Thirty cases of neglected (more than three weeks) femoral neck fracture (Pauwel II and III) of age 20-60 years were included in the study conducted at Postgraduate Institute Of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India in year 2004-06. Average age of the patient was 35.4 years (range, 22yrs-55yrs). In all cases internal fixation was done by 120° double angle barrel plate and hip Screw. At the end of follow-up, results were evaluated according to Askin Bryan Criteria and Harris-hip score. Results Union was achieved in 28 of 30 patients. Two patients that went into nonunion were later treated with hemireplacement arthroplasty. According to Askin Bryan Criteria at the end of study, 35% patients had excellent results, 50% patients had good results. Minimum follow-up in our study was 12 months and maximum was five years. Conclusion This study validates the use of double angled screw plate configuration for successful outcome in patients with neglected fracture neck of femur. Valgus osteotomy is also technically easy operation in hands of average trauma surgeon with the use of a fixed angle plate and hip screw.DOI: http://dx.doi.org/10.3126/kumj.v11i2.12491 Kathmandu University Medical Journal Vol.11(2) 2013: 147-151

scholarly journals Surgical management of basicervical fracture neck of femur with dynamic hip screw and derotation screw: a prospective study

2019 ◽  
Vol 5 (4) ◽  
pp. 712
Author(s):  
Vijaykumar S. Kulambi ◽  
Ajay Shringeri Satish ◽  
Prathik Rangaraja
Keyword(s):  
Functional Outcome ◽  
Dynamic Hip Screw ◽  
Harris Hip Score ◽  
Care Hospital ◽  
Fracture Union ◽  
Neck Of Femur ◽  
Fracture Neck Of Femur ◽  
Hip Screw ◽  
One Year ◽  
Modified Harris Hip Score

<p class="abstract"><strong>Background:</strong> Basicervical region of femur is that part of femur which is intermediate between neck and intertrochanteric region. Fracture in this region carry substantially higher chances of failure due to greater fracture angle and are rotationally unstable. If treated inadequately they carry very high chances of fracture non-union and theoretically risk of osteonecrosis. The objective of the study was to analyse functional outcome of basicervical fracture neck of femur fixation with dynamic hip screw and de-rotation screw in a tertiary care hospital.</p><p class="abstract"><strong>Methods:</strong> 35 cases of basicervical fracture neck of femur admitted in Chigatteri General Hospital and Bapuji Hospital affiliated to JJM Medical College Davangere, in the period of October 2015 to October 2018. Functional outcome was assessed according to Modified Harris Hip Score after one year of follow up.<strong></strong></p><p class="abstract"><strong>Results:</strong> The fracture union was found in 100% cases, average time period for fracture union was 12.28±3.71 weeks (11-15 weeks range). The results according to Modified Harris hip score were excellent in 70%, good in 11.4%. good in 5.7% and poor in 2.8% at the end of one year. The correlation analysis with Pearson’s correlation coefficient (r) was 0.74 which show a highly positive correlation between the union of basicervical fracture neck of femur with dynamic hip screw and derotation screw.</p><p><strong>Conclusions:</strong> With the study of 35 cases of basicervical fracture neck femur we conclude that these are a unique type of fractures mid-way between neck and intertrochanteric fractures with rotational and axial instability, and also risk of osteonecrosis. DHS allows for controlled collapse of the fracture for uneventful healing, and de-rotation screw gives rotational stability. </p>

scholarly journals Outcome of fibular strut graft and two cannulated hip screws in neglected fracture neck of femur in adults - 10 years review

2019 ◽  
Vol 6 (1) ◽  
pp. 25-30
Author(s):  
Rajendra Sanjel Chhetri ◽  
Kishor Prashad Khatri ◽  
Krishna Kharel
Keyword(s):  
Avascular Necrosis ◽  
Delayed Union ◽  
Harris Hip Score ◽  
Outcome Analysis ◽  
Fracture Union ◽  
Neck Of Femur ◽  
Strut Graft ◽  
Non Union ◽  
Fracture Neck Of Femur ◽  
Fibular Strut

Introductions: Avascular necrosis and non-union are common but when the neck of femur fracture in adult is neglected, the chances of complications rises. Among various treatment options, we report the outcome of free fibular strut graft along with two cannulated hip screws in neglected fracture neck of femur. Methods: The outcome analysis of ‘fibular strut graft and two cannulated hip screws’ was conducted in patients with fracture neck of femur who presented at least three weeks after the time of injury, during August 2008 to December 2017, at Lumbini Zonal Hospital and Lumbini Hospital Technical College, Butwal, Nepal. All adult patients aged 18 to 60 years were included. Outcome variables were healing of fracture (union, delayed union, non-union), avascular necrosis and Harris Hip Score (HHS). Results: Out of 20 fractures, 17 (85%) united uneventfully, 2 (10%) had delayed union and 1 (5%) nonunion. We had 3 (15%) avascular necrosis of femoral head. The HHS was excellent in 8 (40%), good in 4 (20%), fair in 6 (30%) and poor in 2 (10%). Conclusions: Fibular Strut graft with two hip screws resulted in fracture union and improved hip functions in patients with neglected fracture of neck of femur.

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

2020 ◽  
Vol 6 (5) ◽  
pp. 316-320
Author(s):  
Dr. Chetan L Rathod ◽  
◽  
Dr. Prakash Chauhan ◽  
Keyword(s):  
Plain Radiograph ◽  
Young Patients ◽  
Dynamic Hip Screw ◽  
Limb Length ◽  
Valgus Osteotomy ◽  
Neck Shaft Angle ◽  
Femur Neck Fracture ◽  
Pin Fixation ◽  
Shaft Angle ◽  
Hip Screw

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.

scholarly journals Clinical Outcome and Biomechanical Analysis of Dynamic Hip Screw Combined with Derotation Screw in Treating Displaced Femoral Neck Fractures Based on Different Reduction Qualities in Young Patients (≤65 Years of Age)

2022 ◽  
Vol 2022 ◽  
pp. 1-15
Author(s):  
Jian Zhu ◽  
Yonglong Li ◽  
Yingze Zhang ◽  
Xiaodong Cheng
Keyword(s):  
Femoral Neck ◽  
Internal Fixation ◽  
Clinical Outcomes ◽  
Young Patients ◽  
Femoral Neck Fractures ◽  
Harris Hip Score ◽  
Surgical Time ◽  
Displaced Femoral Neck Fractures ◽  
Reduction Group ◽  
Hip Screw

Objective. To examine the clinical results and biomechanical mechanism of the dynamic hip screw (DHS) and derotation screw (DS) in the treatment of displaced femoral neck fractures (FNF) based on different reduction qualities in young patients (≤65 years of age). Methods. All patients with FNF who received closed reduction and internal fixation with DHS+DS from January 2014 to August 2019 were retrospectively analyzed. Data on demographics, surgery, clinical outcomes, and postoperative complications were collected. According to the reduction quality immediately after surgery, all patients were categorized into the positive buttress reduction group (PBRG) and the anatomical reduction group (ARG). The complications and clinical outcomes were compared between the two groups. Meanwhile, the biomechanical mechanism of different reduction qualities was further analyzed with finite element analysis (FEA). The distribution of von Mises stress, the peak stress of internal fixation, and the displacement of the proximal fragment were compared between the two groups. Results. A total of 68 patients were included in our study. Among them, 31 were divided into the PBRG while 37 were in the ARG. The surgical time and fluoroscopy time were significantly shorter in the PBRG than in the ARG ( p < 0.05 ). The degree of femoral neck shortening and the varus change of the femoral-neck shaft angle were lower in the PBRG compared to the ARG ( p < 0.05 ). The excellent-good rate of the Harris hip score was higher in the PBRG compared to the ARG (83.9% vs. 64.8%). The FEA results demonstrated that the stress of DHS+CS and the downward displacement of the proximal femoral neck fragment were greater in the ARG than in the PBRG. Conclusion. For displaced FNF with difficulty to achieve reduction, DHS+CS combined with positive buttress reduction was an effective treatment in young patients due to better mechanical support, shorter surgical time, less radiation exposure, and higher excellent-good rate of Harris hip score.

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

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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