Femoral neck non-union treatment by valgus intertrochanteric osteotomy.

Carlos Roberto Schwartsmann,Leandro De Freitas Spinelli,Marcelo Faria Silva,Anthony Kerbes Yépez,Leonardo Carbonera Boschin

doi:10.1590/1413-785220152306148750

Carlos Roberto Schwartsmann, Leandro De Freitas Spinelli + Show 3 more

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https://doi.org/10.1590/1413-785220152306148750

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Abstract

ABSTRACTOBJECTIVE: The purpose of this study was to evaluate the performance of valgus intertrochanteric osteotomy in femoral neck non-union.METHODS: Forty-two patients with femoral neck fractures with non-union treated using Pauwels' intertrochanteric osteotomy were reviewed. Demographics, time elapsed between fracture and surgery, follow--up, osteosynthesis used, Garden's classification, limb shortening, and x-rays were evaluated. RESULTS: Twenty-two men and 20 women were reviewed. The youngest patient was 18 years old and the oldest 65 years old, with a mean age of 42.4 years (±11.2). The minimum follow-up was 2 years, with a mean of 10.2 years. The average time elapsed between initial fracture and osteotomy was 6.5 months. Twel-ve cases were neglected femoral neck fractures. Nineteen patients were classified as Garden III, and 23 patients as Garden IV. After valgus osteotomy, non-union healing was observed in 38 patients (38/42; 90.4%). Healing of thirty-seven cases of pseudoarthrosis were obtained after the first-attempt osteotomy, and one case required two operations for healing. The osteotomy failed in four cases. Conside-ring the healed osteotomies, good to excellent functional results were achieved in 80.9% (34/42) of the patients. Total hip replacement was subsequently performed in 14.2% (6/42) of the patients for unfavoura-ble outcomes (two for cutting out, two for osteonecrosis, and two for osteoarthritis).CONCLUSIONS: Valgus intertrochanteric osteotomy has a high success rate in archiving healing in femoral neck non-union with good functional results. It is a biological and effective method. Level of Evidence IV, Therapeutic Study.

Highlights

Non-union and avascular necrosis of the femoral head are the main complications of fractures of the femoral neck
If the patient is older than 65 years and presents a displaced fracture, there is a consensus for the use total hip replacement, eliminating the recurrence of the main complications of the biological alternative and providing rapid pain relief and early mobilization
The decision to treat with valgus intertrochanteric osteotomy was based on chronological and physiological age, good bone stock, and sphericity of the femoral head based on the x-rays obtained

Summary

Introduction

Non-union and avascular necrosis of the femoral head are the main complications of fractures of the femoral neck. Pauwels showed that a higher shearing angle could lead to an unfavourable consolidating process. For this reason, a valgus osteotomy converts shearing into compression forces and increases the fracture healing potential.[1] The consolidation of the pseudoarthrosis with the preservation of the femoral head is the biological alternative and can offer the best long-term results for the young patient. If the patient is older than 65 years and presents a displaced fracture, there is a consensus for the use total hip replacement, eliminating the recurrence of the main complications of the biological alternative (pseudoarthrosis and aseptic necrosis) and providing rapid pain relief and early mobilization. The purpose of this study was to evaluate the performance of valgus intertrochanteric osteotomy in the treatment of femoral neck non-union

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Results

Conclusion