Role of valgus osteotomy and fixation with dynamic hip screw and 120° double angle barrel plate in the management of neglected and ununited femoral neck fracture in young patients

Abstract

BackgroundHead preservation is the mainstay of management in younger patients with neglected or ununited intracapsular fracture neck of femur. Very few reports have dealt with the results of valgus intertrochanteric osteotomy and fixation with dynamic hip screw in such cases. In this prospective study, we have tried to evaluate the role of valgus osteotomy and fixation with dynamic hip screw and 120° double angle barrel plate in neglected or ununited intracapsular fracture neck of femur in patients below 60 years of age and whose time since injury is equal to or more than 3 weeks.Materials and methodsWe treated 16 such cases with valgus intertrochanteric osteotomy and fixation achieved with dynamic hip screw and 120° double angle barrel plate, with mean age of 36.4 years. The cases were evaluated radiologically and clinically at a mean of 19 months.ResultsIn 14 of the 16 patients, the fracture went on to satisfactory union after an average of 14.7 weeks (10–26.7 weeks). The average Harris hip score increased from 66.6 points (range 55–75 points) before surgery to 88 points (range 75–95 points). All the patients with united fractures were able to sit cross-legged, squat and do one-leg stance. Pain and limitation of motion improved remarkably. Two patients had unfavourable outcome; both had cut-through of the implant, out of the head.ConclusionsValgus intertrochanteric osteotomy is a very cheap and effective procedure to achieve union in neglected and ununited fracture neck femur in young patients. We propose fixation with dynamic hip screw and 120° double angle barrel plate as it provides additional compression and, with valgus osteotomy, improved stability of internal fixation, with few complications.

Valgus Osteotomy and Repositioning and Fixation with a Dynamic Hip Screw and a 135° Single-Angled Barrel Plate for Un-United and Neglected Femoral Neck Fractures

“…The blade plate hammer can displace the fracture and a slight change in the direction of the blade makes fixation to the shaft very difficult. 12 Perforation and splitting of the femoral head by chisel and blade are possible risks. 7,11 Compression across the fracture cannot be achieved with an angled blade plate, but is possible with the dynamic hip screw.…”

“…7,11 Compression across the fracture cannot be achieved with an angled blade plate, but is possible with the dynamic hip screw. 12,19 We used a 135º single-angled barrel plate rather than a 120° double-angled one. 12,19 The latter may cause medialisation and verticalisation of the femoral shaft, straining of the medial ligament of the knee, valgus deformity, and ultimately osteoarthritis.…”

“…12,19 We used a 135º single-angled barrel plate rather than a 120° double-angled one. 12,19 The latter may cause medialisation and verticalisation of the femoral shaft, straining of the medial ligament of the knee, valgus deformity, and ultimately osteoarthritis. 20 In addition, single-angled plates enable lateralisation and normal orientation of the femoral shaft, thus counteracting the medialisation and vertical orientation produced by the osteotomy.…”

“…The 135º single-angled barrel plate prevented medialisation of the proximal femoral shaft and maintained its anatomy. In the original closed wedge valgus osteotomy, 7,[9][10][11][12] the osteotomy was at the intertrochanteric level and fixed with a doubleangled plate by abducting the distal segment.…”

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

“…7,8 This study was aimed at assessing the role of double angled barrel plate with DHS implant for fixing the valgus osteotomy and hence evaluating the effectiveness of 30 degree fixed closing wedge valgus osteotomy in treating neglected fracture neck of femur.…”