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. 2015 Nov-Dec;23(6):319-22.
doi: 10.1590/1413-785220152306148750.

Femoral neck non-union treatment by valgus intertrochanteric osteotomy

Carlos Roberto Schwartsmann  1 , Leandro de Freitas Spinelli  2 , Anthony Kerbes Yépez  2 , Leonardo Carbonera Boschin  2 , Marcelo Faria Silva  3
Affiliations

Femoral neck non-union treatment by valgus intertrochanteric osteotomy

Carlos Roberto Schwartsmann et al. Acta Ortop Bras. 2015 Nov-Dec.

Abstract

Objective: : 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.

Keywords: Femoral neck fractures; Hip/surgery.; Osteotomy.

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Conflict of interest statement

All the authors declare that there is no potential conflict of interest referring to this article

Figures

Figure 1
Figure 1. Femoral neck fracture (A); (B) failure of initial osteosynthesis treat-ment with two cannulated screws; (C) post-operative valgus intertrochanteric osteotomy; (D) and (E) pelvis x-ray showing the consolidation of valgus os-teotomy and healing of non-union neck fracture in one year and 7 years later.
Figure 2
Figure 2. Functional results after healing of neck non-union.
See this image and copyright information in PMC

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