Non-union fracture neck femur in a young patient

Abstract

An 18-year-old boy fell 1 year ago from a tree and sustained righthip injury,whichwas treatedby traction.Atpresentation, 15 years ago, hehadpain, deformity and 300 shortening andwas unable tobearweighton right leg.X-rayof the righthip showed non-union with resorption of neck of femur and proximal migration of femur (Fig. 1), but the head seemed viable. A corrective valgus osteotomy with the fixation of fracture was done using a Dynamic Hip Screw (DHS)with a 135 angle 4 hole plate. The patient did very well and both the osteotomy and fracture united without any avascular necrosis of the femoral head (Fig. 2). At 15 years follow up, the patient came for a routine implant removal (Fig. 3), when he was totally asymptomatic and has had only 1 cm of residual shortening of right hip and almost full range of hip movements. The implants were removed without any significant event (Fig. 4). Fracture neck of femur in young is rare and usually occur due to severe injuries like road traffic accident (RTA), fall from height etc. If the displaced fractures are not treated early then it is often associated with complications. Non-union is one of the commonest complications. Treatment of non-union of these fractures in young is quite challenging. An attempt to save the natural femoral head and hip joint is a priority and hence corrective valgus osteotomy with fixation of the fracture with stable implant is a good choice and may achieve union and preserve the natural hip joint, as it was in our case. Joint replacement may be a secondary choice but considering the young age of these patients, an attempt to fix the fracture along with a corrective osteotomymust be considered first, as it may preserve a natural hip joint.