Top

Journal of Orthopaedics and Traumatology

Published in:

Open Access 01-06-2009 | Original Article

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

Authors: Abdul Qayyum Khan, Mohammad Shahnawaz Khan, Mohammed Khalid Anwar Sherwani, Rahul Agarwal

Published in: Journal of Orthopaedics and Traumatology | Issue 2/2009

Abstract

Background

Head 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 methods

We 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.

Results

In 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.

Conclusions

Valgus 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.

Barnes JT, Brown JT, Garden RS, Nicoll EA (1976) Subcapital fractures of the femur: a prospective review. J Bone Joint Surg 58B:2–24

Zetterberg C, Elmerson S, Andersson GBJ (1984) Epidemiology of hip fractures in gotesberg 1940–1983. Clin Orthop 191:43–52PubMed

Maninger J, Kazar C, Fekete C et al (1989) Significance of urgent (within 6h) internal fixation in the management of fractures of the neck of the femur. Injury 20:101–105CrossRef

Barnes B, Dunovan K (1987) Functional outcomes after hip fracture. Phys Ther 67:1675–1679PubMed

Huang CH (1986) Treatment of neglected femoral neck fractures in young adults. Clin Orthop 206:117–126PubMed

Lifeso R, Young D (1990) The neglected hip fracture. J Orthop Trauma 4:287–292PubMedCrossRef

Nagi ON, Dhillon MS, Gill SS (1992) Fibular osteosynthesis for delayed type II and type III femoral neck fractures in children. J Orthop Trauma 6:306–313PubMedCrossRef

Banks HH (1974) Nonunion in fractures of the femoral neck. Orthop Clin North Am 5:865–885PubMed

Jackson M, Learmonth ID (2002) The treatment of non union after intracapsular fracture of the proximal femur. Clin Orthop 399:119–128PubMedCrossRef

10.

LeCroy CM, Rizzo M, Gunneson EE et al (2002) Free vascularised fibular bone grafting in the management of femoral neck non union in patients younger than fifty years. J Orthop Trauma 16:464–472PubMedCrossRef

11.

Pauwels F (1976) Biomechanics of the normal and diseased hip. Springer, Berlin, pp 129–271CrossRef

12.

Mueller ME (1999) The intertrochanteric osteotomy and pseudoarthrosis of the femoral neck. Clin Orthop 363:5–8PubMedCrossRef

13.

King T (1939) Closed operation for intracapsular fracture of the neck of the femur. Br J Surg 26:721CrossRef

14.

Lu-Yoa GL, Keller RB, Littenberg B, Wenliberg JE (1994) Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. J Bone Joint Surg Am 76:15–23

15.

Garden RS (1964) Stability and union in subcapital fractures of the femur. J Bone Joint Surg Br 46:630–647PubMed

16.

Dalen N, Jacobson B (1986) Rarefied femoral neck trebecular patterns, fractures displacement and femoral head vitality in femoral neck fractures. Clin Orthop 207:97–98PubMed

17.

Hammer AJ (1992) Nonunion of subcapital femoral neck fractures. J Orthop Trauma 6:73–77PubMed

18.

Baksi DP (1986) Internal fixation of ununited femoral neck fracture combined with muscle-pedicle bone grafting. J Bone Joint Surg Br 68:239–245PubMed

19.

Zukerman JD, Koval KJ (1993) Hip trauma. In: Frimoyer JW (ed) Orthopaedic knowledge update 4. American Academy of Orthopaedic Surgeons, Rosemont, pp 525–538

20.

Nagi ON, Dhillon MS, Goni VG (1998) Open reduction, internal fixation and fibular autografting for neglected fracture of the femoral neck. J Bone Joint Surg Br 80-B:798–804CrossRef

21.

Pauwels F (1935) Der Schenkelhalsbruch ein mechanisches Problem: Grundlagen des Heilungsvorganges, Prognose and kausale Therapie. Ferdinand Enke Verlag, Stuttgart

22.

Rinaldi E, Marengh P, Negri V (1984) Osteosynthesis with valgus osteotomy in the primary treatment of subcapital fractures of the neck of the femur. Ital J Orthop Traumatol 10(3):313–320PubMed

23.

Marti RK, Schuller HM, Raaymakers EL (1989) Intertrochanteric osteotomy for nonunion of the femoral neck. J Bone Joint Surg Br 71:782–787PubMed

24.

Anglen JO (1997) Intertrochanteric osteotomy for failed internal fixation of femoral neck fracture. Clin Orthop 341:175–182PubMedCrossRef

25.

Zehi K, Bouguira A, Saadaoui F et al (2001) Valgus osteotomy in the treatment of pseudoarthrosis of the femoral neck. Rev Chir Orthop Reparatice Appar Mot 87:562–568

26.

Frangakis EK (1966) Intracapsular fractures of the neck of the femur: factors influencing non-union and ischaemic necrosis. J Bone Joint Surg Br 48-B:17–30

27.

Brodetti A (1960) The blood supply of the femoral neck and head in relation to the damaging effects of nails and screws. J Bone Joint Surg Br 42-B:794–801

28.

Aginsky J, Reis ND (1980) The present state of medullary nailng of the femur: biomechanical limitations and problems of blood supply to the fracture due to reaming. Injury 11:190–196PubMedCrossRef

29.

Braten M, Terjesen T, Svenningsen S, Kibbsgaard L (1990) Effect of medullary reaming on fracture healing: tibial osteotomies in rabbits. Acta Orthop Scand 61:327–329PubMedCrossRef

30.

Ballmer FT, Ballmer PM, Baumgartel F, Ganz R, Mast JW (1990) Pauwels osteotomy for nonunions of the femoral neck. Orthop Clin North Am 21:759–767PubMed

31.

Walcher K, Wiesinger H (1983) Pauwels valgization osteotomy or alloplasty in pseudarthrosis of the femur neck. Aktuel Traumatol 13:34–41PubMed

32.

Weber BG, Cech O (1973) Schenkelhals-pseudarthrose. In: Weber BG, Cech O (eds) Pseudarthro sen: pathophysiology, biomechanics, therapy, results. Verlag Hans Huber, Bern, pp 141–179

33.

Catto M (1965) A histological study of avascular necrosis of the femoral head after transcervical fracture. J Bone Joint Surg Br 47-B:749–776

34.

Raaymakers Ernst LFB, Marti Rene K (2008) Nonunion of the femoral neck: possibilities and limitations of the various treatment modalities. Indian J Orthop 42:13–21PubMedCentralPubMedCrossRef

35.

Kirby H (2002) Femoral neck non-union: osteotomy or arthroplasty. Tech Orthop 17(4):434–442CrossRef

Title: 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
Authors: Abdul Qayyum Khan
Mohammad Shahnawaz Khan
Mohammed Khalid Anwar Sherwani
Rahul Agarwal
Publication date: 01-06-2009
Publisher: Springer International Publishing
Published in: Journal of Orthopaedics and Traumatology / Issue 2/2009
Print ISSN: 1590-9921
Electronic ISSN: 1590-9999
DOI: https://doi.org/10.1007/s10195-009-0049-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Background

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2009

Septic physeal separation of proximal femur in a newborn

Increased serum OPG in atrophic nonunion shaft fractures

Lipoma of Guyon’s canal causing ulnar neuropathy

Instability of the pelvic ring and injury severity can be predictors of death in patients with pelvic ring fractures: a retrospective study

A case of bilateral luxatio erecta

Thoracolumbar burst fracture with complete paraplegia: rationale for second-stage anterior decompression and fusion regarding functional outcome