Non-union of femoral neck fractures with osteonecrosis of the femoral head: treatment with combined free vascularized fibular grafting and subtrochanteric valgus osteotomy

Modified Pauwels’ Intertrochanteric Osteotomy in Neglected Femoral Neck Fracture

“…A 20°to 30°wedge is sufficient to place the head of femur into valgus and larger intertrochanteric wedges of bone based on Pauwels' angle are not required [18]. Bone graft donor-site morbidity associated with other procedures is avoided [3,14,25,28]. A satisfactory outcome can still be achieved through a revision osteotomy or arthroplasty if the initial procedure fails [12,20].…”

“…Furthermore, open reduction is likely to interfere in an already precarious blood supply of the head of the femur [29]. Vascularized fibular grafting [3,14] reportedly has achieved 100% union; however, vascularized fibular grafting with or without osteotomy is time-consuming, requires a high degree of technical skill, and is beyond the competence of the typical orthopaedic surgeon [29]. Valgus osteotomy with or without bone grafting and THA have been widely accepted as the only two viable options for treatment of femoral neck nonunion [10,11,16,20,21,24,27,30].…”

Valgus osteotomy for nonunion and neglected neck of femur fractures

“…For patients with the aim of hip salvage, assessing the vascularity of the head may only be of academic value. However, a report of a small series of patients with nonunion and documented AVN who underwent valgus osteotomy with vascularized fibular graft demonstrated that arrest of AVN was achieved in 3 out of the 5 patients [24] .…”

Fixation with Cancellous Screws and Fibular Strut Grafts for Neglected Femoral Neck Fractures

“…Treatment options include valgus osteotomy and osteosynthesis with or without bone grafting (muscle pedicle, free vascularised, or nonvascularised fibula), hemiarthroplasty, and total hip arthroplasty. [1][2][3][4][5][6][7][8][9] Nonunion and avascular necrosis are common complications. Closed reduction and internal fixation is usually not feasible after 3 weeks, as the femoral neck begins to resorb causing avascular necrosis and nonunion.…”