Treatment of nonunion after femoral neck fracture with valgus intertrochanteric osteotomy: a case report with 18-year follow-up

We herein report the long-term effect of valgus intertrochanteric osteotomy for nonunion after femoral neck fracture. In this report, we describe our experience using valgus intertrochanteric osteotomy to treat nonunion after femoral neck fracture in a 20-year-old woman. The patient was discharged from the hospital 10 days after the operation, the internal fixation device was removed 1 year after the operation, and the patient was then followed up for 18 years. Valgus intertrochanteric osteotomy can effectively treat nonunion after adductive femoral neck fracture.

Valgus Intertrochanteric Osteotomy for Salvage of Failed Femoral Cervicotrochanteric Fracture Fixation

BackgroundFemoral cervicotrochanteric fracture fixation failure often requires a salvage procedure to preserve the hip. To understand its limitations, this study investigated the use of intertrochanteric osteotomy for this purpose and analyzed causes of failure.MethodsDuring 2001 − 2017, 21 patients (males:females = 12:9; 47 ± 17 years) with failed femur cervicotrochanteric fracture fixation were treated with intertrochanteric osteotomy. All patients were followed-up using functional assessment according to the Harris hip score (HHS) and radiological assessment. The clinical end-point was conversion to hip arthroplasty for any reason or acquiring a symptomatic hip with a HHS < 80.ResultsWith a follow-up duration of 124 ± 63 months, success was achieved in 16 patients, whereas 5 patients developed fixation failure. Early failure was associated with fixation loss in 2 hips with subcapital fractures, while late failure was related to progression of pre-existing osteonecrosis of the femoral head (ONFH) in 3 hips. Aside from the 2 early failure hips, the osteotomy healed uneventfully in all cases, and the original fracture sites healed within 17.2 ± 6.3 weeks. Of the 5 hips converted to arthroplasty, standard femoral implants were used without the need to re-perform an osteotomy to align the medullary canal. At the final follow-up, significant improvements in limb-length discrepancy (LLD), neck-shaft angle (NSA), and HHS were observed. The valgus osteotomy angle for correction was 21.9° ± 8.4°, and this was maintained at 21.1° ± 10.5° during follow-up.ConclusionsIntertrochanteric osteotomy is a useful operation and can promote fracture-healing in cases of failed cervicotrochanteric fracture fixation. Subcapital fracture with limited bone to enable secure purchase of the fixation device and pre-existing ONFH were associated with high failure rates. In such cases, salvage should not be attempted using this procedure alone, and arthroplasty or other salvage procedures may be necessary.

Principles of Valgus Intertrochanteric Osteotomy (VITO) after Femoral Neck Nonunion

Nonunion is a relatively rare, yet challenging problem after fracture of the femoral neck. Risk factors include verticality of the fracture line and presence of comminution of the posteromedial calcar, as well as quality of reduction. Treatment options consist of valgus intertrochanteric osteotomy versus arthroplasty. Treatment should be tailored to the individual patient, taking into account patient age and activity demands. This review outlines the principles and technical considerations for valgus osteotomy of the proximal femur in the setting of femoral neck nonunion.