Valgus osteotomy in delayed presentation of femoral neck fractures using fixed angle simple dynamic hip screw and plate

Nayak, Chandrakant; Acharyya, Biplab; Jain, Mantu; Kamboj, Kulbhushan

doi:10.1016/j.cjtee.2018.12.003

Cited by 7 publications

(6 citation statements)

References 23 publications

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“…Applying such a valgus correction indeed converted the shear force on the fracture plane to a compression force during weight-bearing and enhanced fracture-healing. [23,24] Indeed, we observed that the original fracture healed (average, 17.2 ± 6.3 weeks) faster than the osteotomy site (average, 5.8 months).…”

Section: Resultsmentioning

confidence: 71%

“…Several authors have described valgus osteotomy and DHS xation. [22][23][24][25] The biomechanical basis of valgus reorientation osteotomy is the conversion of the nonunion plane to a more horizontal plane, rendering it perpendicular to the axis of load transmission, and thus creating a more favorable fracture-healing environment. [26] For valgisation osteotomy, full-wedge, half-wedge and no-wedge techniques have been described.…”

Section: Resultsmentioning

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: 71%

Section: Resultsmentioning

confidence: 99%

Valgus Intertrochanteric Osteotomy for Salvage of Failed Femoral Cervicotrochanteric Fracture Fixation

Odeh¹,

et al. 2020

Preprint

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“…The post-op shortening in this study in the cases treated with Modified Pauwel's Osteotomy with internal fixation was statistically compared with Magu et al [20] study article Magu et al found a mean limb length discrepancy of 1.9 cm in a sample size of 8 cases (n = 8). The maximum shortening observed was 2.5 cm while the minimum was 1.5 cm.…”

Section: Comparisionmentioning

confidence: 59%

Long Term Results of Valgus Intertrochanteric Osteotomy in Old Fracture Neck of Femur – A Prospective Analysis

Choudhury¹,

Gupta²,

Nayak³

et al. 2022

ojot

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A prospective study (data collected retrospectively from January 2011 to December 2018) was conducted in the department of orthopaedics in SCB Medical College and Hospital from December 2018 to December 2020 on patients with old fracture neck of femur. A total of 42 cases were included for the study who had undergone this surgery before December 2019. Valgus Intertrochanteric Osteotomies included McMurray’s Osteotomy, Modified Pauwel’s Osteotomy and Transfracture Abduction Osteotomy. Thirty six patients were followed up only as Six patients could not be contacted. Valgus Intertrochanteric Osteotomy of proximal femur was found to be the mainstay of the treatment in young patients. Initially Mc Murrays Osteotomy was preferred but in recent times modified Pauwel’s Intertrochanteric Valgus Osteotomy and Trans Fracture Abduction Osteotomy was considered as an augmentation to the healing of a fracture neck of femur which presented late. Keywords: Valgus intertrochanteric osteotomy, Old neck of femur fracture, Fixation

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“…A 135° plate might preferentially be used when there is a degree of coxa valga. Nayak et al [ 18 ] assessed the results of valgus osteotomy in femoral neck fracture fixation. They reported a series of 20 patients with a fractured neck of the femur with associated high Pauwels angle, presenting late, wherein valgus osteotomy was added to their reduction and fixation and was secured with a 135° DHS.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Tip-Apex Distance at Various Angles of Fixation Devices in Hip Fractures

Ali¹,

Al‐Dadah²

2023

Cureus

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BackgroundIntertrochanteric neck of the femur (NOF) fractures are very common, and the majority are fixed using dynamic hip screws (DHS) or intramedullary (IM) nails with a fixed angle. The aim of this study was to assess which angle of fixation has a better tip-apex distance (TAD) on X-ray and lower complication rates. MethodsWe included patients with intertrochanteric hip fractures fixed using a DHS or an IM nail. We included patients who had complete radiological and clinical records and a minimum follow-up of 24 months. We measured the TAD and recorded the number of implant cutouts, fracture site nonunions, and periprosthetic fractures. ResultsA total of 107 patients were included, 35 IM nails and 72 DHS. There were four cases of implant cutouts within the DHS group and none in the IM nail group. All four cutout cases were fixed using 135° angle DHS, and two had TAD of more than 25 mm. Multivariable regression analysis revealed that the implant fixation device (p=0.002) and the angle of fixation (p<0.001) are the most important predictors of TAD. ConclusionSmaller angle (130° or 125°) fixation devices allow better positioning of the lag screw and consequently better TAD, which leads to a lower probability of implant cutout in patients undergoing fracture of the neck of the femur surgery.

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Valgus osteotomy in delayed presentation of femoral neck fractures using fixed angle simple dynamic hip screw and plate

Cited by 7 publications

References 23 publications

Valgus Intertrochanteric Osteotomy for Salvage of Failed Femoral Cervicotrochanteric Fracture Fixation

Valgus Intertrochanteric Osteotomy for Salvage of Failed Femoral Cervicotrochanteric Fracture Fixation

Long Term Results of Valgus Intertrochanteric Osteotomy in Old Fracture Neck of Femur – A Prospective Analysis

A Comparison of Tip-Apex Distance at Various Angles of Fixation Devices in Hip Fractures

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