Subtrochanteric Valgus Osteotomy of Non-United Fracture Neck Femur by Dynamic Hip Screw

Makhan  Lal; Barun Golwara; Subodh Sharma; Anjit Kumar

Makhan Lal Assistant Professor, Department of Orthopedics, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India.
Barun Golwara Assistant Professor, Department of Orthopedics, Government Medical College, Bettiah, Bihar, India.
Subodh Sharma Assistant Professor, Department of Orthopedics, Nalanda Medical College and Hospital, Patna, Bihar, India.
Anjit Kumar Assistant Professor, Department of Orthopedics, Patna Medical College and Hospital, Patna, Bihar, India.

Keywords: Subtrochanteric Valgus Osteotomy, Non-United Fracture Neck.

Abstract

Background: Non-union and avascular necrosis of the femoral head is the main complications of fractures of the femoral neck. Valgization osteotomy is a therapeutic option that is considered to be effective for treating consolidation failure of transtrochanteric fractures. Hence; the present study was undertaken for assessing efficacy of Subtrochanteric Valgus Osteotomy of Non-United Fracture Neck Femur by Dynamic Hip Screw.

Methods: A total of 20 patients with non-united fracture of femur neck were enrolled. Complete demographic details of all the patients were obtained. All the patients underwent Subtrochanteric Valgus Osteotomy under the hands of skilled and experienced orthopaedic surgeons. Pre-operative assessment of all the patients was done (both clinical and radiographic). Post-operative follow-up was done and outcome was evaluated by using Harris hip screw and change in neck shaft angle. All the results were recorded in Microsoft excel sheet and were analysed by SPSS software.

Results: Mean duration of surgery was found to be 69.2 minutes. Mean blood loss was found to be 380.5 ml. Mean time for fracture union was found to be 11.2 weeks. Mean preoperative neck shaft angle was 102.1° and it improved significantly after treatment reaching a postoperative value of 137.9°. Mean preoperative Harris hip score was 42.8 and it improved significantly after treatment reaching a postoperative value of 88.4.

Conclusions: Subtrochanteric Valgus Osteotomy by Dynamic Hip Screw for non-United Fracture Neck Femur provides adequate results with excellent prognosis. However; further studies were recommended.

Downloads

Download data is not yet available.

Author Biographies

Barun Golwara, Assistant Professor, Department of Orthopedics, Government Medical College, Bettiah, Bihar, India.

Subodh Sharma, Assistant Professor, Department of Orthopedics, Nalanda Medical College and Hospital, Patna, Bihar, India.

Anjit Kumar, Assistant Professor, Department of Orthopedics, Patna Medical College and Hospital, Patna, Bihar, India.

References

1. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular frac-tures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51(4):737–55.
2. Schwetlick G, Weber U, Klingmuller V. The femoral neck pseudarthrosis following medial femoral neck fracture. An indication for the vascularized pedicled iliac crest transplant. Unfallchirurg. 1989;92:73–8.
3. Weber BG, Cech O. Schenkelhals-pseudarthrose. In: Weber BG, Cech O, editors. Pseudarthro sen: Pathophysiology, Biomechanics, therapy, results. Bern: Verlag Hans Huber; 1973. pp. 141–79.
4. Dickson JA. The unsolved fracture; a protest against defeatism. J Bone Joint Surg Am. 1953;35(4):805–22.
5. Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg Br. 1985;67(1):3–9.
6. Pauwels F. Biomechanics of the normal and diseased hip. Springer Science and Business Media: 1976.
7. Stewart MJ, Wells RE. Osteotomy and osteotomy combined with bone grafting for non-union following fracture of the femoral neck. J Bone Joint Surg Am. 1956;38:33–49.
8. Calandruccio RA, Anderson WE. Post-fracture avascular necrosis of the femoral head: Correlation of experimental and clinical studies. Clin Orthop Relat Res. 1980;152:49–84.
9. Ghosh B, Bhattacharjya B, Banerjee K, Bera AK. Management of non-united neck femur fracture by valgus osteotomy--a viable alternative. J Indian Med Assoc. 2012 Nov;110(11):819-20.
10. Schwartsmann CR, Spinelli Lde F, Yépez AK, Boschin LC, Silva MF. Femoral neck non-union treatment by valgus intertrochanteric osteotomy. Acta Ortop Bras. 2015;23(6):319–22. doi:10.1590/1413-785220152306148750
11. Abdelazeem H, Abdelazeem A2, Al-Dars A, Hegazy M, Abdellatif N. Triple attack technique for non-union of femoral neck fractures. Int Orthop. 2016 Apr;40(4):807-12.