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

Abstract

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 <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.

Keywords

• internal fixation
• intertrochanteric osteotomy
• kirschner wires
• neck-shaft angle