Evaluation of valgus intertrochanteric osteotomy in neglected fracture neck femur in young adults

Abstract

We believe that intertrochanteric osteotomy provides a good outcome for neglected femoral neck fractures. Performing the procedure on a routine table, with Watson Jones approach and fixing with double angle blade plate is a good option.

Total Hip Arthroplasty for the Sequelae of Femoral Neck Fractures in the Pediatric Patient

“…In addition to very poor bone health markers, the patient in the present study possessed all of these risk factors, and it is therefore not unexpected that the left femoral neck fracture went on to nonunion. In the absence of other complicating factors such as femoral head ON and degenerative joint changes, nonunion of the femoral neck can be managed with the modified Pauwels' intertrochanteric osteotomy [33][34][35][36][37]. This valgus osteotomy works by converting shear forces to compressive forces, and a contoured blade plate is typically used to maintain the new neck-shaft angle created by the osteotomy [33][34][35][36].…”

“…In the absence of other complicating factors such as femoral head ON and degenerative joint changes, nonunion of the femoral neck can be managed with the modified Pauwels' intertrochanteric osteotomy [33][34][35][36][37]. This valgus osteotomy works by converting shear forces to compressive forces, and a contoured blade plate is typically used to maintain the new neck-shaft angle created by the osteotomy [33][34][35][36]. In neglected femoral neck fractures such as in the present case, union rates as high as 100% have been reported after modified Pauwels' intertrochanteric osteotomy [33][34][35][36].…”

An unusual presentation of femoral neck fracture in a young patient

“…In young patients, preservation of the femoral head is preferable with joint replacement reserved as a last resort. A number of fixation methods have been used with varying success [ 7 ]. Valgus intertrochanteric osteotomy, where a lateral wedge is removed at the upper border of the lesser trochanter, allows lateral displacement of the distal fragment and valgus correction of the deformity.…”

“…This has been shown to be successful in treating missed femoral neck fractures with favourable outcomes [ 3 , 6 – 8 ]. However, under-correction of the deformity can lead to failure of the fixation [ 7 ] and subsequent conversion to hip replacement will technically be more difficult as a secondary procedure [ 8 ].…”

Triple attack technique for non-union of femoral neck fractures

“…Various procedures with variable results have been reported. There is no standard protocol for choosing one over another for a particular fracture [1][2][3][4][5][6][7][8].…”