Valgus osteotomy and repositioning and fixation with a dynamic hip screw and a 135º single-angled barrel plate for un-united and neglected femoral neck fractures.

Abstract

PURPOSE:

To review the outcome of 60 patients who underwent valgus subtrochanteric osteotomy and its repositioning for un-united and neglected femoral neck fractures.

METHODS:

60 patients (mean age, 35 years) underwent valgus subtrochanteric osteotomy and repositioning of the osteotomy and fixation with a dynamic hip screw and a 135° single-angled barrel plate for closed un-united femoral neck fractures after failed internal fixation (n=27) or neglected (>3 weeks) fractures (n=33). The most common fracture type was transcervical (n=48), followed by subcapital (n=6) and basal (n=6). All patients had displaced femoral neck fractures (Garden types 3 and 4). According to the Pauwel angle, 45 fractures were type 2 (30º-70º) and 15 were type 3 (>70º).

RESULTS:

Patients were followed up for a mean of 3.5 (range, 2-7.5) years. The mean Pauwel angle of the fracture was corrected from 65° (range, 50°-89°) to 26° (range, 25°-28°). Bone union was achieved in 56 patients after a mean of 3.9 (range, 3-5.5) months. The mean Harris hip score improved from 65 to 87.5. Outcome was excellent in 30 patients, good in 24, and poor in 6. Four of the patients developed avascular necrosis; 2 of whom nonetheless achieved a good outcome.

CONCLUSION:

Valgus osteotomy and repositioning and fixation with a dynamic hip screw and a 135° single-angled barrel plate was effective treatment for un-united and neglected femoral neck fractures.

• Authors: Sameer Gupta, Sunil Kukreja, Vivek Singh
• Journal: Journal of orthopaedic surgery (Hong Kong) (J Orthop Surg (Hong Kong)) Vol. 22 Issue 1 Pg. 13-7 (Apr 2014) ISSN: 2309-4990 [Electronic] England
• PMID: 24781606 (Publication Type: Journal Article)

Topics

• Adult
• Bone Plates
• Bone Screws
• Female
• Femoral Neck Fractures (diagnostic imaging, physiopathology, surgery)
• Follow-Up Studies
• Fracture Fixation, Internal (instrumentation)
• Fracture Healing
• Fractures, Ununited (diagnostic imaging, physiopathology, surgery)
• Hip Joint (physiopathology)
• Humans
• Male
• Middle Aged
• Osteotomy (methods)
• Radiography
• Range of Motion, Articular
• Retrospective Studies
• Time Factors
• Treatment Outcome