Femoral neck non-union treatment by valgus intertrochanteric osteotomy

Abstract

OBJECTIVE: The purpose of this study was to evaluate the performance of valgus intertrochanteric osteotomy in femoral neck non-union.METHODS: Forty-two patients with femoral neck fractures with non-union treated using Pauwels' intertrochanteric osteotomy were reviewed. Demographics, time elapsed between fracture and surgery, follow--up, osteosynthesis used, Garden's classification, limb shortening, and x-rays were evaluated. RESULTS: Twenty-two men and 20 women were reviewed. The youngest patient was 18 years old and the oldest 65 years old, with a mean age of 42.4 years (±11.2). The minimum follow-up was 2 years, with a mean of 10.2 years. The average time elapsed between initial fracture and osteotomy was 6.5 months. Twel-ve cases were neglected femoral neck fractures. Nineteen patients were classified as Garden III, and 23 patients as Garden IV. After valgus osteotomy, non-union healing was observed in 38 patients (38/42; 90.4%). Healing of thirty-seven cases of pseudoarthrosis were obtained after the first-attempt osteotomy, and one case required two operations for healing. The osteotomy failed in four cases. Conside-ring the healed osteotomies, good to excellent functional results were achieved in 80.9% (34/42) of the patients. Total hip replacement was subsequently performed in 14.2% (6/42) of the patients for unfavoura-ble outcomes (two for cutting out, two for osteonecrosis, and two for osteoarthritis).CONCLUSIONS: Valgus intertrochanteric osteotomy has a high success rate in archiving healing in femoral neck non-union with good functional results. It is a biological and effective method. Level of Evidence IV, Therapeutic Study.

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

“…Before the osteotomy, limb length discrepancy was present in 24 patients. Valgus osteotomy led to the equalization in 16 patients [7]. In the current study, the success rate of valgus osteotomy was measured as 90%.…”

“…However, the rate of hip replacement is associated with the followup duration. This is because degenerative changes progress with time and total hip replacement could become necessary [7].…”

“…This technique converts shearing forces into compression; accordingly, increasing the healing potential of the bone [6]. A union rate of 80%-90% was reported following the valgus osteotomy of FNN in different studies [5,7,8]. If valgus osteotomy provides a safe and effective treatment for FNN, it could be suggested as the method of choice for treating this complication.…”

Femoral Neck Non-Union - A Biomechanical Solution with Valgus Sliding Subtrochanteric Osteotomy: A Case Report

“…Schwartsmann et al 3 reported good outcome treating femoral neck non-union with valgus osteotomy. They have stated their preference of DHS over angle blade plate given DHS provides rigid stability, is less aggressive, easier to perform, and allows compression over non-union site.…”

“…However, there are contraindications to valgus osteotomy such as osteonecrosis with incongruence, poor bone quality and reabsorption. However, radiographic evidence of osteonecrosis alone without collapse is not a contraindication 3 .…”