Valgus osteotomy for nonunion and neglected neck of femur fractures

Varghese, Viju Daniel; Livingston, Abel; Boopalan, P.R.J.V.C.; Jepegnanam, Thilak Samuel

doi:10.5312/wjo.v7.i5.301

Cited by 30 publications

(40 citation statements)

References 38 publications

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“…Valgus osteotomy xation with blade plates has been described in the literature by several authors. [7,[18][19][20] Blade plates have excellent rotational control but are technically di cult to use. Varghese et al [18] studied 32 patients who developed femoral neck non-unions and were treated using valgus osteotomy and blade-plate xation.…”

Section: Resultsmentioning

confidence: 99%

“…Several authors have reported success using such a procedure. [7][8][9] We reported a technique of valgus intertrochanteric osteotomy based on preoperative templating in 21 patients with xation failure of cervicotrochanteric fractures. We further analyzed the cases in which the procedure failed in order to understand the limitations of this salvage procedure.…”

Section: Introductionmentioning

confidence: 99%

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Valgus Intertrochanteric Osteotomy for Salvage of Failed Femoral Cervicotrochanteric Fracture Fixation

Odeh¹,

et al. 2020

Preprint

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BackgroundFemoral cervicotrochanteric fracture fixation failure often requires a salvage procedure to preserve the hip. To understand its limitations, this study investigated the use of intertrochanteric osteotomy for this purpose and analyzed causes of failure.MethodsDuring 2001 − 2017, 21 patients (males:females = 12:9; 47 ± 17 years) with failed femur cervicotrochanteric fracture fixation were treated with intertrochanteric osteotomy. All patients were followed-up using functional assessment according to the Harris hip score (HHS) and radiological assessment. The clinical end-point was conversion to hip arthroplasty for any reason or acquiring a symptomatic hip with a HHS < 80.ResultsWith a follow-up duration of 124 ± 63 months, success was achieved in 16 patients, whereas 5 patients developed fixation failure. Early failure was associated with fixation loss in 2 hips with subcapital fractures, while late failure was related to progression of pre-existing osteonecrosis of the femoral head (ONFH) in 3 hips. Aside from the 2 early failure hips, the osteotomy healed uneventfully in all cases, and the original fracture sites healed within 17.2 ± 6.3 weeks. Of the 5 hips converted to arthroplasty, standard femoral implants were used without the need to re-perform an osteotomy to align the medullary canal. At the final follow-up, significant improvements in limb-length discrepancy (LLD), neck-shaft angle (NSA), and HHS were observed. The valgus osteotomy angle for correction was 21.9° ± 8.4°, and this was maintained at 21.1° ± 10.5° during follow-up.ConclusionsIntertrochanteric osteotomy is a useful operation and can promote fracture-healing in cases of failed cervicotrochanteric fracture fixation. Subcapital fracture with limited bone to enable secure purchase of the fixation device and pre-existing ONFH were associated with high failure rates. In such cases, salvage should not be attempted using this procedure alone, and arthroplasty or other salvage procedures may be necessary.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Valgus Intertrochanteric Osteotomy for Salvage of Failed Femoral Cervicotrochanteric Fracture Fixation

Odeh¹,

et al. 2020

Preprint

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“…After nonunion following DHS on the right hip, we opted for THA. Other treatment options, such as valgus intertrochanteric osteotomy with DHS or blade plate fixation in order to compress and stabilize the stress fracture by converting shear forces to compressive ones, have been described with variable failure rates [25,26]. Valgus intertrochanteric osteotomy permits a more horizontal Advances in Orthopedics reorientation of the stress fracture line by subtracting a wedge on the lateral femur ( Figure 7).…”

Section: Discussionmentioning

confidence: 99%

Total Hip Arthroplasty for Bilateral Femoral Neck Stress Fracture: A Case Report and Review of the Literature

Moerenhout

Gkagkalis

Laflamme

et al. 2019

Advances in Orthopedics

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Femoral neck stress fractures (FNSFs) can be treated conservatively or surgically, depending on initial displacement and patient condition. Surgical treatment options include internal fixation, with or without valgus osteotomy or hip arthroplasty, either hemi or total. The latter is mainly considered when initial treatment fails. A review of the literature shows that total hip arthroplasty (THA) is only considered as primary treatment in displaced fractures (type 3) in low-demand patients. We present a case of successive bilateral FNSF in a young active patient, where a THA was performed on one side, after failed internal fixation, and where it was chosen as primary treatment on the other side after failed conservative treatment.

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“…Valgus intertrochanteric osteotomy converts femoral neck forces from shear to compression in these patients (10). Valgus intertrochanteric osteotomy protects the bone stock and has successful outcomes in young patients (10).…”

Section: Discussionmentioning

confidence: 99%

“…Al- In young patients, osteosynthesis of neglected femoral neck fractures is difficult and it has a high risk of avascular necrosis (10). Valgus intertrochanteric osteotomy converts femoral neck forces from shear to compression in these patients (10).…”

Section: Discussionmentioning

confidence: 99%

Neglected Femoral Neck Fracture Associated with Pregnancy: Case Report

Fidan¹,

Çetin²,

Kazdal³

et al. 2017

JAREM

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Transient osteoporosis is a self-limiting condition mostly seen in third trimester of pregnancy. MRI is a noninvasive method for the diagnosis of transient osteoporosis in pregnancies with hip and pelvic pain. We present a 28-year-old primipar with a 3-month history of left hip pain one month after delivery. Garden type 3 fracture was detected. The patient underwent intertrochanteric valgus osteotomy and osteosynthesis. Twenty months of follow-up did not reveal any complications such as nonunion or AVN. In the case of hip pain in pregnancy, the diagnosis of transient osteoporosis with MRI can be made early and more serious complications can be avoided. Successful results can be obtained with intertrochanteric valgus osteotomy in the treatment of neglected femur neck fracture in young patients.

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Valgus osteotomy for nonunion and neglected neck of femur fractures

Abstract: Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics.

Cited by 30 publications

References 38 publications

Valgus Intertrochanteric Osteotomy for Salvage of Failed Femoral Cervicotrochanteric Fracture Fixation

Valgus Intertrochanteric Osteotomy for Salvage of Failed Femoral Cervicotrochanteric Fracture Fixation

Total Hip Arthroplasty for Bilateral Femoral Neck Stress Fracture: A Case Report and Review of the Literature

Neglected Femoral Neck Fracture Associated with Pregnancy: Case Report

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