Valgus Intertrochanteric Osteotomy Research Articles

Valgus Osteotomy versus Arthroplasty for Ununited Femoral Neck Fractures: A Systematic Review

Abstract Background Fractures of the neck of femur in young adults tend, unlike their counterparts in older people, to be a relatively higher energy injury and require timely and meticulous diagnosis and management. Anatomical reduction and stable internal fixation are essentials for achieving the goals of treatment in this young population allowing preservation of the femoral head while minimizing rates of non-union and osteonecrosis. Aim of the Work The aim of this systematic review is to collate evidence from comparative studies to look for significant differences between valgas osteotomy &arthroplasty in non united femoral neck fractures in < 50yr old patients. Patients and Methods Only studies with Randomized controlled trials and comparative non controlled trials had been included. The study included Valgas osteotomy & arthroplasty for ununited femoral neck fractures. Application of inclusion and exclusion criteria to study Abstracts yielded 11articles. The full-text articles for these 40 studies were then reviewed and subjected to our inclusion criteria. A total of 11 articles were eligible for final systematic review. Results There was improvement in Harris hip score in all included studies ranged from 79.8 to 95. In comparison between two groups, groups with THA had significantly higher Harris hip score than osteotomy score. In this review reoperation and infection were common among osteotomy group than total hip arthroplasty group. Conclusion Although non-union problems following femoral neck fractures are common, the primary objective is to preserve the hip, by seeking alternative methods, specifically in young patients, and considering that the femoral neck can usually remain viable. Therefore, alternatives such as valgus osteotomy, which enables union by solving mechanical issues and allows patients to live with their own bones, have long been in use and successful Valgus intertrochanteric osteotomy is the treatment of choice for active patients aged less than 50 years with a nonunion of a femoral neck fracture. This technique requires precise preoperative planning and intraoperative skill. Patients should be warned of the risk of avascular necrosis, as well as the difficulty in performing revision arthroplasty in this setting.

A Pilot Study of Functional Outcomes in Adult Patients Treated With Valgus Intertrochanteric Osteotomy as a Primary Modality for Intracapsular Femoral Neck Fracture.

Background Intracapsular femoral neck fractures account for a majority of hip fractures. This study aimed to investigate the efficacy of valgus osteotomy as a primary treatment for intracapsular femoral neck fractures in adult patients aged 15-60 years, assessing its impact on functional outcomes and fracture union. Methodology A retrospectiveclinical analysis was conducted at the Department of Orthopedics and Traumatology, Osmania Government General Hospital, Hyderabad, India, focusing on patients treated with primary intertrochanteric valgus osteotomy for intracapsular femoral neck fractures. The study reviewed medical charts and radiographs of six patients aged between 15 and 60 years, diagnosed with recent isolated intracapsular femoral neck fractures, presenting between May 2019 and October 2021. The intervention involved Pauwels' intertrochanteric valgus osteotomy with various fixation methods. Main outcome measures included radiographic union, functional ability assessed by the Harris Hip Score, and evaluation for complications. Results All six patients achieved radiographic union at fracture and osteotomy sites, totaling a 100% success rate. The average follow-up duration was 14.8 months (12-20 months), with an average time of 5.1 months (2.5-6 months) from surgery to radiographic union. One patient experienced union with retroversion, while another developed avascular necrosis (AVN) by the study's conclusion. No instances of hardware failure or non-union were observed. The average Harris Hip Score obtained during the most recent clinical follow-up was 84, ranging from 69 to 94. All six patients regained independent walking ability without any support by the end of the follow-up period. Conclusion The combination of primary Pauwels' intertrochanteric valgus osteotomy with fixed-angle plating proves to be a highly effective method for addressing recent intracapsular femoral neck fractures, resulting in a 100% success rate in achieving union among the patient cohort.

Low reoperation rate after fixation of displaced femoral neck fractures with the femoral neck system (FNS).

Operative fixation of femoral neck fractures (FNFs) remains challenging. Complications are not infrequent, especially in displaced patterns. Numerous fixation techniques have been previously described in the literature; however, there remains a paucity of data regarding outcomes of these injuries treated with the femoral neck system (FNS). Patients with a displaced FNF (OTA/AO 31B) treated with the FNS at a single level 1 academic trauma center between 1/1/2019 and 1/1/2023 were identified. Radiographs were reviewed to assess fracture displacement, location, and characteristics. Patient records were further reviewed to assess for complications, reoperations, and osseous union. Forty-three patients (65% male) with 44 FNFs were identified with a mean age of 35.0years (range, 13-61years). Two patients developed a deep infection requiring surgical debridement, four patients underwent a total hip arthroplasty, and one patient underwent a valgus intertrochanteric osteotomy for nonunion. There were three cases of femoral head AVN. Mean follow-up was 482.5days among all patients, and 36 fractures had at least 6months of follow-up or reached bony union. Here, we present a series of patients treated with the FNS for internal fixation and report a 18% reoperation rate. This is lower than the average rate that has been previously reported in similar patient populations in the literature treated with alternative methods of internal fixation. Thus, the FNS appears to be a safe and effective option for treatment of these injuries.

Functional adaptation after femoral intertrochanteric valgus osteotomy in Legg–Calvé–Perthes disease

Legg–Calvé–Perthes disease (LCPD) requires individualized treatment in order to regain a functional hip joint. In severe cases, in which a congruent joint cannot be achieved, other options are necessary in order to improve functionality and prevent early osteoarthritis. Therefore, we analysed the clinical and radiologic outcome of 28 patients after valgus osteotomy of the proximal femur (VOF). We examined the range of hip motion, functionality and health-related quality of life (HRQoL) via modified Harris Hip Score (mHHS) and Kidscreen-10. Radiographic analysis contained quantitative and qualitative measurements of hip morphology. In particular, we correlated the results with the change of the pelvic-femoral angle (PFA). PFA was defined as the angle between the anatomical diaphyseal line of the femur and a vertical line through the pelvis. The mean follow-up was 5.5 years. Patients showed high mHHS and good HRQoL postoperatively. An increase in ROM with an improvement of 30.5° abduction and 10.3° internal rotation was evident. PFA correlated with adduction contracture and improved significantly after surgery. In consideration of careful patient selection, VOF showed a positive effect on ROM, pain, HRQoL, radiographic congruence and outcome. We identified the age at surgery and an increasing adduction contracture—objectified by a decreased PFA—as a prognostic factor.

Long-term results of valgus intertrochanteric osteotomy for partial avascular necrosis of the femoral head after femoral neck fracture in adolescents

PurposeThe study evaluates long-term results in patients treated by valgus intertrochanteric osteotomy (VITO) for partial avascular necrosis of the femoral head (ANFH) after fracture of the femoral neck in adolescent age. Although this method is mentioned in literature frequently, there are only few studies in the literature dealing with it in detail.MethodsAuthors evaluated five patients at the interval of 15 to 20 years following VITO. The mean age of the patients at the time of injury was 13.6 years and at the time of VITO 16.7 years. The studied parameters included resorption of necrotic segment of femoral head, development of posttraumatic osteoarthritis and leg shortening.ResultsComparison of radiographs and MRI scans before and after VITO showed resorption of the necrotic segment of the femoral head and its remodeling in all five patients. However, two patients gradually developed slight osteoarthritic changes. In one patient, remodeling of the femoral head occurred during the first 6 years postoperatively. Subsequently, the patient developed severe osteoarthritis with marked clinical symptoms.ConclusionVITO can improve the long-term function of the hip joint in adolescents with ANFH after a femoral neck fracture, but cannot restore completely the original shape and structure of the femoral head.

Valgus Osteotomy for Non-Union Fracture Neck of Femur in a Child: A Case Report

Paediatric neck of femur fractures is rare and incorporates less than 1% of all the paediatric fractures. Complications of femoral neck fractures in children includes necrosis (AVN) of femoral head, non-union and premature closure of the proximal femoral physis— resulting in decrease of growth, coxa vara and limb-length discrepancies. In past, the incidence of non-union varied from 7% to 10%, depending on the location of the fracture in the neck of femur the incidence of non-union in these fractures have significantly reduced in the recent times due to early anatomical reduction and rigid internal fixation. Due to the small number of cases, the treatment protocols for non-union of the paediatric femoral neck fractures are not well defined. Valgus osteotomy changes the shearing force at the non-union site to compression forces which provides optimal environment for bone union. Here we present a case of 6 years old child who presented with non-united fracture of the neck of femur with coxa vara, 1 year after conservatively treated osteomyelitis of proximal femur with valgus intertrochanteric osteotomy.

Efficacy of cheilectomy in patients with bilateral healed legg calves perthes disease

Legg calves Perthes disease (LCPD) is caused mainly due to idiopathic osteonecrosis or AVN of the proximal femoral epiphysis leading to remodelling during period of development, this will gradually progress into onset of hip osteoarthritis depending upon the rate at which the sphericity and congruency of the femoral head deteriorate. LCPD is usually associated with a hinge abduction deformity, in this condition the major aspherical portion of the head is shifted laterally, in such deformity; Valgus intertrochanteric osteotomy has to been utilized for correction. Cheilectomy deals with excision of exuberant portion of femoral head epiphysis, thereby eliminating hinged abduction and facilitating containment, which also maintains the blood supply, buy protecting the surrounding soft tissue structures. We have included 10 patients for this study, from age group 9-16yrs, between July 15th to April 18. The criteria for patient selection being primarily adolescent age with radiological evidence of LCPD, with coxa plana and decreased range of motion. Patient under 10 years of age and with history of previous surgeries have been excluded. All the patients were planned preoperatively and operated under spinal anaesthesia. Through posterior kocherlangenback approach, capsulotomy was doneposterior-superiorly and lateral protuberance was identified and excised. A common feature through most surgeries being femoro-acetabular impingement (CAM type) secondary to aspherical femoral head. There were a total of 7 cases of complex CAM type deformities and 3 pincer induced deformities. Postoperatively weight bearing and ROM was restricted for 4 weeks. Physiotherapy protocol was followed for improving ROM. Patients were followed at 4,8,12 weeks to evaluate clinical and radiological progress.Majority of the patient experienced improved pain after surgical intervention and 1 patient had worsening of pain at 3 months of followup. 2 patients had complication of delayed wound healing due to superficial infections. No further complications such as osteonecrosis and non-union were not observed.Though this study we can conclude that osteochondroplasty of the femoral head and neck performed in conjunction with other procedures, through the surgical dislocation of hip approach has improved pain and restored function in a majority of the patients, while avoiding any dreaded complications. Although the results were satisfactory in a 3 month follow up, we may conclude that a long term follow up is needed for the efficacy of this method in restoration of painless joint function and avoidance of arthroplasty at a later date.

VALGUS INTERTROCHANTERIC OSTEOTOMY USING DYNAMIC HIP SCREW FOR NEGLECTED NON-UNION OF NECK OF FEMUR FRACTURE IN A MIDDLE AGED MALE-A CASE REPORT.

Neck of femur fracture is a common orthopaedic problem. The management of the non union of the neck of femur is challenging because of the biological and the mechanical factors at play. Osteosynthesis is the modality of choice for the people aged 60 years or less while arthroplasty is the treatment offered for the older age group. Numerous techniques have been described for the osteosynthesis of the non union of neck of femur. The main principle of all these methods remains optimization of the biology and mechanics of the fracture to promote fracture union and delay the onset of hip arthritis. Here we describe a case of a young middle aged male who due to ongoing COVID-19 pandemic and the imposed lockdowns was not able to receive proper healthcare. He presented to us with 9 months duration of nonunion of right neck of femur fracture. Radiographs were obtained which revealed a Pauwels type 3 fracture and a Sandhu class 2 nonunion. MRI studies were done to ascertain the viability of the femoral head. After all the investigations, a decision was taken to attempt head salvage using a Valgus intertrochanteric Osteotomy. Careful preoperative assessment and calculations were done to accurately determine the osteotomy wedge, DHS pin insertion angle and the goal Pauwels angle. It was decided to correct the Pauwels angle to 30° to reduce shear forces at the fracture site and achieve compression at the fracture site. After the surgical procedure patient was followed up and the fracture as well the osteotomy site showed the signs of union at 24 weeks post operative. Patient achieved excellent function in his hip. He was able to walk pain and limp free, he could squat, sit crosslegged and perform his day to day activites as well as his ground level activites. His post operative Harris Hip Score was 90.8(excellent) at 24 weeks follow up. We thus conclude that a carefully planned valgus intertrochanteric osteotomy is able to achieve excellent outcomes in young patients with non union of neck of femur.

Valgus inter-trochanteric osteotomy and fixation with double angle barrel plate and Richard screw for neglected fracture neck femur in young adults – A prospective clinico-radiological cohort study

Background: Saving natural head is the primary aim of management in delayed presented intracapsular fracture neck of femur, especially in young population. Anatomical reduction of these fractures is a difficult task. Rather more difficult is to decide the method of fixation which might require additive procedure(s) and one such method is valgus osteotomy and fixation devices which are technically demanding. Aims and Objectives: Our aim is to evaluate the practicality and validity of valgus osteotomy and fixation with Richard screw and double angle barrel plate in delayed presented (more than 3 weeks) fracture neck of femur in young adults. Materials and Methods: We treated 18 patients with mean age of 39 years who presented late with valgus inter-trochanteric osteotomy and fixed with Richard screw and double angle barrel plate. The cases were evaluated radiologically and clinically for Harris hip score, limb length discrepancy, union time, neck-shaft angle and complications such as avascular necrosis and implant cut through. Results: 15 out of 18 patients (83%) united in an average period of 15 weeks (12–28 weeks) clinically as well as radiologically. In more than 70% of patients, the average Harris hip score was “Excellent to Good” (Harris hip score >80). Pre-operative Pauwel’s angle has been corrected from 72.5 to 33. All the patients with united fracture were able to walk with full weight bearing, sit cross legged, squat, and perform SLR and do one-leg stance. Conclusion: Fixation with Richard screw and120° double angle barrel plate provides rigid bony fixation and restore the limb length after valgus inter-trochanteric osteotomy. Valgus inter-trochanteric osteotomy is an effective method to achieve union in neglected fracture neck of femur, as it facilitates added compression at fracture site and stable internal fixation.

Long-Term Outcome of Valgus Osteotomy and Fixation with Double Angled Dynamic Hip Screw for Nonunion Fracture of the Neck of the Femur in Young Adults.

Objective To evaluate the long-term results of valgus intertrochanteric osteotomy fixed with double angled dynamic hip screw for nonunion fracture of the neck of the femur in young adults. This implant allows more freedom of fixation in the sagittal plane. Very few studies have evaluated the long-term outcome for treatment of nonunion in fractures of the neck of the femur. Methods This is a prospective interventional study that included 20 patients with nonunion of the fracture of the neck of the femur aged < 60 years old without avascular necrosis of the head and significant resorption of the neck of the femur. A lateral closing wedge osteotomy was performed just above the lesser trochanter after inserting the Richard screw across the nonunion site, and it was fixed with a double-angle 120° barrel plate. The outcome was evaluated using union rate and the Harris Hip Score for functional outcome. Results The average postoperative decrease in the Pauwels angle was of 28.9°. A total of 80% of the cases progressed to union within a mean duration of 7.53 months. The mean Harris Hip Score at the final follow-up was 86.45. Conclusion Valgus intertrochanteric osteotomy and fixation with a double angled dynamic hip screw is a reliable and effective method for preservation of head and promoting union in an ununited fractured neck of the femur in young patients.

Outcome of valgus osteotomy in recent fracture of neck of femur with powels angle more than 50 degree

Background: Vertical femur neck fractures are prone to nonunion due to shear forces. This mechanical component that causes nonunion is corrected with intertrochanteric valgus osteotomy. Osteotomy has historically been reserved for fractures that have been neglected for more than three weeks or for nonunion following screw fixation failure. In the primary therapy of a fracture neck of the femur, valgus repositioning osteotomy is not a conventional method. In this study, we assess this management strategy as an alternate treatment for specific conditions. Patients and Methods: This study comprised 12 adult patients with recent vertical femoral neck fractures. The age ranged from 20 to 48 years old. Ten guys and two ladies were present. There were seven mid-cervical fractures and five subcapital fractures. Vertical fractures were treated with valgus osteotomy (angle more than 50 degrees). Due to renal insufficiency, three individuals developed osteoporotic fractures. The intertrochanteric osteotomy was performed to transform shear pressures into compression forces with the goal of reducing the fracture angle to 25 degrees. The average follow-up time was 45 months. Results: The average postoperative angle was 28 degrees.

Long Term Results of Valgus Intertrochanteric Osteotomy in Old Fracture Neck of Femur – A Prospective Analysis

A prospective study (data collected retrospectively from January 2011 to December 2018) was conducted in the department of orthopaedics in SCB Medical College and Hospital from December 2018 to December 2020 on patients with old fracture neck of femur. A total of 42 cases were included for the study who had undergone this surgery before December 2019. Valgus Intertrochanteric Osteotomies included McMurray’s Osteotomy, Modified Pauwel’s Osteotomy and Transfracture Abduction Osteotomy. Thirty six patients were followed up only as Six patients could not be contacted. Valgus Intertrochanteric Osteotomy of proximal femur was found to be the mainstay of the treatment in young patients. Initially Mc Murrays Osteotomy was preferred but in recent times modified Pauwel’s Intertrochanteric Valgus Osteotomy and Trans Fracture Abduction Osteotomy was considered as an augmentation to the healing of a fracture neck of femur which presented late. Keywords: Valgus intertrochanteric osteotomy, Old neck of femur fracture, Fixation

Intertrochanteric valgus osteotomy for post-traumatic coxa vara after proximal femur fractures: A retrospective study.

To investigate the clinical effects of a new intertrochanteric valgus osteotomy technique designed by the authors for treatment of post-traumatic coxa varus after proximal femur fractures. Retrospectively analyzed 11 patients who developed coxa vara after sustaining proximal femoral fractures were treated with intertrochanteric valgus osteotomy from December 2005 to December 2018 in our hospital. This study included 6 cases of intertrochanteric fracture deformity union, 3 cases of subtrochanteric fracture nonunion and 2 cases of femoral neck fracture nonunion. Measured the degree of coxa varus, the differences in the lower limb length and force line in all patients. Evaluated hip function with the Harris hip score. All injuries were treated with the authors’ intertrochanteric valgus osteotomy technique. The average follow-up period was 3 years and evaluated the clinical effects by radiological examination and the Harris hip score. The average neck–shaft angle increased 35.0° (99.1°–134.1°) and the average limb shortening lengthened 1.9 cm (2.9–1.0 cm) after surgery. The average operating time was 67.2 minutes and blood loss was 237.7 ml. The osteotomy position healed in all patients 3 months later. Union of the 2 old femoral neck fractures was achieved 4 and 6 months after surgery, respectively, and no femoral head necrosis occurred during follow-up. The Harris hip score increased an average of 49 points (44.1–93.1 points) at 1 year postoperatively. Our self-designed intertrochanteric valgus osteotomy technique showed a favorable clinical effect to treatment coxa vara and can be used in the clinical setting.

Role of Valgus Osteotomy and Fixation with Double Angle Blade Plate in the Management of Neglected and Ununited Femoral Neck Fracture

Introduction: Femoral neck fracture non union in young patients is a challenging complication as joint replacement is not readily recommended and hip salvageable procedures are relatively unsatisfactory. Valgus intertrochanteric osteotomy described by Pauwels F is one of the treatment options for management of non union of femoral neck in young patients, which was later reciprocated by other surgeons. Aim: To assess the efficacy of valgus osteotomy and fixation with double angle blade plate in the management of neglected and ununited femoral neck fracture. Materials and Methods: This was a prospective cohort study, which included 30 patients of femoral neck fracture non union in whom intertrochanteric valgus osteotomy was performed and fixed with 120° double angled blade plate. The preoperative and postoperative neck-shaft angle was compared using the paired t-test. A p-value of &lt;0.05 indicated statistically significant result. Results: There were 22 males (73.3%) and 8 females (26.7%). Mean age of patients was 35 years. Delay in presentation ranged from 8 weeks to 58 weeks (mean 24 weeks). By Pauwel’s classification, there were 13 Type II fractures and 17 Type III fractures. Mean follow- up was 18 months (12 to 36 months). The mean preoperative neck- shaft angle of 95° (range 80-110°) increased to 132° (range 120- 140°) after surgery. In all patients, there was improvement in leg length discrepancy after osteotomy. Femoral neck fractures united in 25 patients (83.3%). Conclusion: Valgus osteotomy and fixation with 120° double angle blade plate is a reliable method for treating non union femoral neck fracture in young adults. It provides rigid internal fixation and good results.

Management of Old Neck Femur Fracture through Valgus Osteotomy and Pin Fixation

Introduction: Valgus intertrochanteric osteotomy alters the biomechanical environment of thefracture site and restores limb length. Very few reports have dealt with the results of this procedureinternally fixed with a dynamic hip screw and double angle barrel plate. Hence, the prospectivestudy was performed at the institution level for the evaluation of results of valgus osteotomy andfixation of the femur neck fracture in young patients. Material and Methods: A total of 32 patientswere included in the study. There were 24 males and 8 females in the study. Before osteotomy, theaverage neck-shaft angle was 101° (80–120°), with an average limb shortening of 2.3cm (1.0–3.2cm). The greater trochanter was up riding in fourteen cases and needed skeletal traction beforesurgery. None of these had evidence of vascular necrosis on plain radiograph or MRI. The fractureswere treated with a dynamic hip screw and double angle barrel plate. The patients had a minimumfollow-up of 14months and a maximum of 42months. Results: In a total of 28 patients the excellentresults were obtained, however in 4 patients the poor result was due to cut – out of implants. Noneof the patients were lost on follow up, the fracture went on to achieve the satisfactory union afterthe minimum of 14 weeks follows up. The average preoperative neck-shaft angle of 101° (range 80–120°) increased to 134° (range 120–145°) after surgery. The average limb length discrepancypostoperatively was 2.3cm. Conclusion: From the study, it was concluded that valgus osteotomyand fixation with dynamic hip screw and 120° double angle barrel plate has a high success rate inyoung patients with neglected and ununited intracapsular fracture neck of the femur as far as theunion of fracture is concerned.

Ipsilateral proximal and shaft femoral fractures treated with bridge-link type combined fixation system

BackgroundAlthough many treatments for ipsilateral proximal and shaft femoral fractures have been developed, controversy exists regarding their optimal management. The purpose of this retrospective study was to discuss the effectiveness of the bridge-link type combined fixation system (BCFS) and evaluate functional outcomes in treating patients with these complex fractures.Patients and methodsWe retrospectively reviewed 14 cases of ipsilateral proximal and shaft femoral fractures treated from January 2012 to December 2016. All cases were treated by BCFS combined with minimally invasive percutaneous plate osteosynthesis (MIPPO). Clinical and radiographic data were collected during regular post-operative follow-up visits. Functional outcomes were determined according to the Friedman and Wyman scoring system.ResultsThe proximal femoral fractures were emergency diagnoses in 11 cases and delayed diagnoses in 3 cases. The delay time was 5–6 days, with an average of 5.3 days. The mean operation time was 179.6 min (range 135–231 min) with a blood loss volume that ranged from 430 to 535 ml (average 483.6 ml). Follow-up was conducted in 13 cases between 9 and 30 months post-operation, with an average follow-up time of 17.3 months. The proximal femoral fractures were united in 12 cases at the final follow-up. One case had nonunion 13 months after the operation, underwent valgus intertrochanteric osteotomy, and healed 6 months later. The femoral shaft fractures obtained rigid union at the latest follow-up in 12 cases. One case endured nonunion 12 months after the operation. After the revision surgery and iliac bone grafting, the fracture healed 6 months later. Eight of the cases had good functional results, 4 had fair results, and results were poor in 1 case at the final follow-up.ConclusionsThe treatment of ipsilateral proximal femoral and shaft fractures with BCFS in combination with MIPPO demonstrated a high likelihood of union for both fractures and good functional results.

Functional and radiological outcome of valgus osteotomy (abduction osteotomy of Pauwel) and fixation with dynamic hip screw in neglected fracture neck of femur

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Despite improvements in the techniques of surgery and internal fixation devices, non-union is still reported in one-third of cases of femoral neck fracture with displacement. Valgus intertrochanteric osteotomy alters the biomechanical environment of the fracture site and restores limb length.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a prospective study on functional outcome of valgus osteotomy and fixation with dynamic hip screw (DHS) in neglected fracture neck of femur in Balaji Institute of Surgery, Research and Rehabilitation for the Disabled (BIRRD), Tirupati. 28 patients were enrolled between December 2017 to December 2019. Patients less than 60 years of age with fracture neck of femur of more than or equal to 3 weeks since injury and with failed primary fixation were included. Patients &amp;gt;60 years of age, patients with avascular necrosis (AVN), and with resorption of femoral neck were excluded.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Among 28 patients 12 had union within 6 months and another 12 within 12 months. 4 patients were lost for follow-up hence considered as non-union. Osteotomy site united by 6 months in 22 patients and by 12 months in 2. Harris hip score was fair to excellent in 24 patients and poor in 4.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Valgus osteotomy and DHS fixation is often a definitive one-time surgical procedure to achieve union in neglected and ununited fracture neck femur in young patients. It is simple and biological. In this study because of the delay in presentation and the young age of patients, Pauwels’ osteotomy was performed as the head-salvaging procedure. Union was achieved in 86% of this study patients.&lt;/p&gt;

Management of neglected neck femur fracture in different age group

Background: Fracture neck femur has been termed as an ‘unsolved fracture’ as it has always presented a great challenge to the orthopaedic surgeons regarding the ideal management and the prognosis. Aims and objectives: To study the incidence, causes and management of neglected fracture neck femur. Materials and methods: Fifty patients having fractures of neck femur presenting after 3 weeks were studied in the Department of Orthopaedics, M.L.B. Medical College, Jhansi, between January 2018 to Aug 2019; after dividing them into two groups. Group A (n=20): patients 3week since injury treated with valgus inter-trochanteric osteotomy and DHS with 120° double angle barrel plate and Group B (n=30): patients >60 years of age with fracture neck of femur of >3week since injury treated with bipolar hemi hip replacement arthroplasty. A detailed history of patient regarding, age, sex, Mode of injury, duration, associated injuries, past history, clinical examination and radiological examination were done along with the X-Ray pelvis. All cases were followed up at monthly interval after surgery for 6 months and then at three monthly intervals for next 6 months, then 6 monthly interval and results evaluated by using Haris Hip Scoring System (HHS). Results: Mean age of patients in Group A was 38.9 years and that in Group B was 74.6 years. Mean Pauwel`s angle, neck shaft angle and limb length shortening and Harris Hip Score was improved post operatively in Group A. The mean HHS in group B preoperatively was 65.6 and after surgery it was increased to 91.4. Quality of internal fixation was satisfactory in 90% cases. Consolidation at osteotomy site was achieved in 95% cases. In 80% cases fracture united within 6 months. In Group B, 4 patients lost to follow up, out of 26 remaining patients, 14 patients had no pain and 10 patients had slight pain at the end of 6 months. Out of these7 patients had no limp and 19 patients had slight limp. At the end of one year, 21 (80.7%) patients could walk more than 1000 meter with single cane. Conclusion: Valgus osteotomy in young and bipolar hemi hip replacement arthroplasty in elders has high success rate in neglected fracture neck of femur.

Long-Term Outcomes of Eccentric Rotational Acetabular Osteotomy Combined With Femoral Osteotomy for Hip Dysplasia

BackgroundThis study aimed at investigating the clinical outcomes of eccentric rotational acetabular osteotomy (ERAO) combined with intertrochanteric valgus osteotomy (ITVO) over a period of more than 10 years. MethodsThis is a case-control study of 39 patients (40 hips) who underwent ERAO combined with ITVO for hip dysplasia (ITVO group). Patients were matched for age, sex, follow-up period, and preoperative joint stage to 78 patients (80 hips) who underwent ERAO alone (ERAO group). We compared the clinical and radiographic outcomes and the survival rates between the groups. ResultsThe Harris Hip Score at the final follow-up was significantly lower in the ITVO group than in the ERAO group. The postoperative center edge angle, acetabular head index, and minimum joint space were significantly smaller in the ITVO group than in the ERAO group. The survival rates for the conversion to total hip arthroplasty end point were not significantly different between groups. However, survival rates for the Harris Hip Score < 80 end point were significantly poorer in the ITVO group than in the ERAO group. ConclusionThe long-term results of ERAO combined with ITVO were not satisfactory from a hip function perspective. ERAO combined with ITVO should be indicated in only young active patients with pre-osteoarthritis and initial stages of osteoarthritis.

Long term clinico-radiological outcome of osteosynthesis in patients with femoral neck fracture: A retrospective study

Introduction: Fracture of the neck of femur continues to be one of the major orthopaedic injuries. It occurs in elderly patients with osteoporosis or in young patients suffering high energy trauma. Aims and Objectives: To evaluate long term clinico-radiological outcome of osteosynthesis in patients with femoral neck fracture. Material and Methods: Fifty patients of femoral neck fracture who underwent osteosynthesis with lag screw fixation or with valgus intertrochanteric osteotomy were studied. The patients were divided into 2 groups; Group-I (n=16) comprised of patients in whom osteosynthesis with lag screws was done and Group-II (n=34) patients had undergone valgus intertrochanteric osteotomy. Results: In Group-I at an average follow up of 41.8 weeks no patient had non-union or AVN, all heads were viable, 6.25% had OA hip & intraarticular implant penetration, 93.7% had Harris hip score from good to excellent, d’Aubigne & Postel score from good to very good & SF-36 score below 10 whereas at an average follow up of 142.37 weeks 6.25% had non-union, 75% heads were viable, 25% had AVN & OA hip, 6.25% had intraarticular implant penetration, 75% had Harris hip score from good to excellent, d’Aubigne & Postel score from good to very good & SF-36 score below 10. In Group-II at an average follow up of 55.44 weeks 2.94% had non-union, 94.12% heads were viable, 5.88% had AVN, 8.82% had OA hip, no intraarticular implant penetration, 88.23% had Harris hip score from good to excellent, 91.17% had d’Aubigne & Postel score from good to very good & 79.41% had SF-36 score below 10 whereas at an average follow up of 159.3 weeks 2.94% had non-union, 82.36% heads were viable, 17.64% had AVN, 41.17% had OA hip, 2.94% had intraarticular implant penetration, 73.53% had Harris hip score from good to excellent, 72.22% had d’Aubigne & Postel score from good to very good & 70.58% had SF-36 score below 10. Conclusion: Rate of union was found to be better in patients managed with valgus intertrochanteric osteotomy than with lag screw osteosynthesis. The incidence of avascular necrosis seems to be higher in patients of group-I as compared to group-II patients. The overall clinical & radiological outcomes in both groups became worse on long term follow up.