Modified Pauwels’ Intertrochanteric Osteotomy in Neglected Femoral Neck Fracture

Magu, Narender Kumar; Rohilla, Rajesh; Singh, Roop; Tater, Rochak

doi:10.1007/s11999-008-0695-4

Cited by 35 publications

(56 citation statements)

References 32 publications

(59 reference statements)

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“…6 Fracture united in 28 patients (Fig 2a,b , Fig 3a,b and Fig 4a,b). Average time for fracture union was 18.6 weeks (range, 14-24 weeks).…”

Section: Resultsmentioning

confidence: 93%

“…Most surgeons use double angled blade plate for internal fixation after osteotomy. [3][4][5][6] In internal fixation by blade plate, at times the blade may displace the fracture fragments and minimal change in the direction of blade may change the direction of plate anterior or posterior to the shaft of femur. Valgus osteotomy fixation with double angle blade plae is also technically demanding.…”

Section: Introductionmentioning

confidence: 99%

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

Bansal

Singhal²,

H³

et al. 2015

Kathmandu Univ. Med. J.

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BackgroundNeglected 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. ObjectivesThe 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. MethodsThirty 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. ResultsUnion 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. ConclusionThis 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.

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“…6 Fracture united in 28 patients (Fig 2a,b , Fig 3a,b and Fig 4a,b). Average time for fracture union was 18.6 weeks (range, 14-24 weeks).…”

Section: Resultsmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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

Bansal

Singhal²,

H³

et al. 2015

Kathmandu Univ. Med. J.

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show abstract

“…While the calculated wedge may be as high as 40 degrees, most authors in the recent literature have reported that a wedge of 25-30 degrees is often sufficient to produce the desired effect [11,14,15] . Even in cases where an osteotomy is not required to obtain a valgus orientation, its advisable to do so as, this may help improve the blood supply to the femoral head.…”

Section: Step 3: Osteotomy and Fixationmentioning

confidence: 99%

“…Neglected NOF fractures are more commonly seen in the developing world [7] and are associated with a particular profile of complications that includes osteopenia, resorption of neck, and avascular necrosis (AVN) [4][5][6] ; unfortunately, these complications are also further detrimental to head salvage. The methods of treating nonunion aim either at improving the biology and bone stock (i.e., non vascularized and vascularized bone grafts [7,8] , muscle pedicle graft) [9] or improving the biomechanics (i.e., valgus osteotomy) [10,11] . The concept of valgus osteotomy was refined by Pauwels [6] in 1927, according to his findings showing that nonunion NOF was due to the high shear forces that increased with the vertical orientation of the fracture.…”

Section: Introductionmentioning

confidence: 99%

“…The proposed biomechanical solution was to redirect these forces into compression forces via an angulation osteotomy and fixation with a blade plate device. Valgus intertrochanteric osteotomy as described by Pauwels [6] and subsequently modified by Muller [12] is still in use today, and remains a popular treatment option as it has a high success rate and corrects the common symptoms of coxa vara and associated limb length discrepancy [11][12][13][14] . Marti et al [10] helped to popularize the valgus intertrochanteric osteotomy for nonunion NOF by reporting good outcome in a long-term follow-up study.…”

Section: Introductionmentioning

confidence: 99%

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