Femoral Neck Non-Union - A Biomechanical Solution with Valgus Sliding Subtrochanteric Osteotomy: A Case Report

Teh Kh,Abbas Aa,Ruben Jk,Chan Ck

doi:10.5704/moj.2007.022

Abstract

Avascular necrosis and non-union are two most dreaded complications of femoral neck fracture fixations. Hip replacement seems to be a simple solution for this complex problem. However, the long-term efficacy of prosthetic replacement in the young population with higher functional demand is still questionable. Femoral head preserving valgus subtrochanteric osteotomies in properly selected cases have strong support from literature. The conventional technique of valgus subtrochanteric osteotomy involves lateral based wedge resection. Alternatively, a simpler sliding oblique subtrochanteric osteotomy without any wedge removal can also be performed. We hereby describe a successful case of sliding subtrochanteric osteotomy with 135° dynamic hip screw (DHS) plate fixation in treating non-union neck of femur fracture in a young gentleman.

Highlights

We report a case of femoral neck non-union in a young adult treated with valgus sliding subtrochanteric osteotomy and the rationale behind it
Femoral neck fracture fixation can be complicated with nonunion, especially in Pauwels type-3 fracture owing to high shearing force across the fracture site, with reported average incidence of 12% in literature[1]
Obtaining anatomic reduction and stable fixation remains the key to successful treatment of femoral neck fractures

Summary

INTRODUCTION

Femoral neck fracture fixation can be complicated with nonunion, especially in Pauwels type-3 fracture owing to high shearing force across the fracture site, with reported average incidence of 12% in literature[1]. A 33-year-old gentleman suffered a left hip neck of femur fracture from a fall. A pelvic radiograph demonstrated a displaced neck of left femur basicervical fracture, Pauwels type-3. He underwent immediate fracture reduction and fixation with two cannulated screws (Fig. 1a). Pelvic radiograph (Fig. 1b) showed non-union over fracture site with slight varus collapse, evident by sclerotic edges of the fracture ends. Six months post-operation, union achieved over both femoral neck non-union site and subtrochanteric osteotomy site. The patient demonstrated excellent Harris hip score with no limb length discrepancy

DISCUSSION

CONFLICT OF INTEREST