Modified Pauwels' Intertrochanteric Osteotomy in Neglected Femoral Neck Fractures in Children: A Report of 10 Cases Followed for a Minimum of 5 Years

Abstract

An MPIO creates a biomechanical environment conducive to healing of a neglected femoral neck nonunion in a child while simultaneously correcting an associated coxa vara. The procedure also seems to have a biological role in helping restore viability to a noncollapsed femoral head with avascular necrosis.

Midterm Results After Subtrochanteric End-to-Side Valgization Osteotomy in Severe Infantile Coxa Vara

“…Thus, it is not surprising that only few studies on their management can be found in the international literature. Most of these studies include a small number of cases [1][2][3][4][5][6] and only 4 studies comprise 20 or more cases. [7][8][9][10] As the few cases that have been written up in the international journals are caused by a multitude of underlying diseases, it is also not astonishing that no broadly accepted classification exists.…”

Modified Valgus Osteotomy for Treatment of Femoral Neck Fracture Non-Union

“…In another study in 2007 on 13 patients, 100% union was reported. In another study in 2007 on 10 non-union cases among children, 100% union was noted [10]. In the largest case-series on 66 non-union of the femoral neck with a mean age of 49.5 years (18-72 years), valgus osteotomy and fixation using angle blade was done and 88% (58 cases) showed union [8].…”

Modified Pauwels’ Intertrochanteric Osteotomy in Neglected Femoral Neck Fracture

“…Osteotomy is a biologic procedure that has been described in various studies [17][18][19][20]. The surgical technique under an image intensifier is simple and can be completed in an average of 58.6 minutes.…”

“…Gain in limb length results from placement of the proximal femur into a more valgus position [21]. In patients with shortening greater than 4 cm, valgization should be combined with lateralization of the distal fragment [19]. In patients with excessive proximal migration of the trochanter and coxa vara, a valgus osteotomy moves the lesser trochanter distally and helps to achieve limb length and neck-shaft angle (Fig.…”