Valgus intertrochanteric osteotomy for neglected femoral neck fractures in young adults

Twenty cases of neglected (more than 1 month old) displaced femoral neck fractures in young adults were treated with a valgus intertrochanteric osteotomy. A fracture union rate of 85% (17 cases) was achieved. Two of the healed cases developed avascular necrosis. After 30 months 15 patients (75%) had achieved good to excellent results. We believe that intertrochanteric osteotomy provides good alternative management for neglected femoral neck fractures.     

Modified valgus osteotomy of the femoral neck for late presenting femoral neck stress fractures in military recruits

Neglected or late presenting femoral neck stress fractures are often associated with varus deformity, with potential risks of nonunion and osteonecrosis. We proposed a surgical technique whereby a wedge osteotomy was performed at the basal part of the neck, on the tensile surface, keeping the inferomedial femoral neck as a hinge. The femoral shaft was abducted to close the osteotomy site and it was fixed with three cannulated cancellous screws. Three military recruits who presented with neglected femoral neck stress fracture with varus deformity were operated on with the proposed modified femoral neck valgus osteotomy. All the fractures united without any complications and the patients resumed their professional activity.     

Valgus intertrochanteric osteotomy for non-union of femoral neck fracture

In spite of improved surgical techniques and fixation devices, non-union still reportedly occurs in 10-30% of cases of femoral neck fracture. A variety of methods of treatment that preserve the femoral head have been described, yet there are few reports on the results of valgus intertrochanteric osteotomy in cases of femoral neck non-union. We treated 11 such cases with valgus intertrochanteric osteotomy performed at one centre and using a single surgical technique. The cases were evaluated clinically and radiographically at a mean of 4.9 years. All of the non-unions were shown radiographically to have healed by an average of 12.5 weeks. Functional outcome was excellent for nine patients and poor for two who underwent subsequent total hip arthroplasty for avascular necrosis of the femoral head. We conclude that valgus intertrochanteric osteotomy is an effective treatment for femoral neck non-union, but avascular necrosis of the femoral head is a possible complication.     

Factors predicting healing complications in femoral neck fractures: 138 patients followed for 2 years

We have previously studied the radiographic outcome of femoral neck fracture osteosynthesis with either two hook-pins or a four-flanged nail performed by a small group of surgeons with special interest in the methods. In 138 femoral neck fractures a backwards stepwise logistic regression analysis was used to study the significance of preoperative fracture-related factors, intraoperative factors and the osteosynthesis. The development of non-union/re displacement and segmental collapse of the femoral head was influenced by fracture displacement (P 0.001) and method of osteosynthesis (P 0.007). The postoperative scintimetric ratio was influenced by the method of osteosynthesis (P 0.0003), fracture displacement (P 0.004) and by the presence of a posterior fragment (P 0.03).

Reduction of the fracture and positioning of the osteosynthesis were to a large extent within the accepted limits. This may explain why the previously well documented negative effects of malpositioning of the osteosynthesis and inferior reduction were not demonstrated to influence the rate of healing-complications. We conclude that neither patient age, sex nor preoperative fracture variables, with the exception of the extent of fracture displacement, can be used to predict radiographic healing-complications in femoral neck fractures.     

Valgus osteotomy for nonunion and neglected neck of femur fractures

Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics.The various treatment options that have been described can be broadly divided according to the aim of improving either biology or biomechanics. Surgeries aimed at improving the biology, such as vascularized fibula grafting, have good success rates but require high levels of expertise and substantial resources. A popular surgical treatment aimed at improving the biomechanics-valgus intertrochanteric osteotomyoptimizes conditions for fracture healing by converting shear forces across the fracture site into compressive forces. Numerous variations of this surgical procedure have been developed and successfully applied in clinical practice. As a result, the proximal femoral orientation for obtaining a good functional outcome has evolved over the years, and the present concept of altering the proximal femoral anatomy as little as possible has arisen. This technical objective supports attaining union as well as a good functional outcome, since excessive valgus can lead to increased joint reaction forces. This review summarizes the historical and current literature on valgus intertrochanteric osteotomy treatment of nonunion neck of femur, with a focus on factors predictive of good functional outcome and potential pitfalls to be avoided as well as controversies surrounding this procedure.     

Pauwels' classification of femoral neck fractures: correct interpretation of the original.

SUMMARY: Pauwels' classification has been in use as a therapeutic guideline since 1935. Although its application is currently limited, it is still referred to and frequently misinterpreted by authors. The causes of this misinterpretation relate first of all to the degrees of the inclination of the fracture line in Degrees II and III of the classification. The correct values of Pauwels' classification are the following: Degree I, up to 30 degrees; Degree II, between 30 and 50 degrees; and Degree III, 50 degrees and more.     

骨外固定架治疗股骨转子间骨折106例疗效分析

目的应用转子型骨外固定架治疗股骨转子间骨折，预防因长期卧床而引起的并发症。方法在C型臂监视下，采用闭合穿针安装转子型骨外固定架，术后患者可早期活动，练习患肢功能。结果本法治疗股骨转子间骨折与传统牵引及其它手术治疗对比，在创伤、恢复时间、经济、并发症等方面占有较大优势。结论在患者骨质及身体状况允许的情况下，应用转子型骨外固定架治疗股骨转子间骨折值得临床推广。     

The medullary expanding compression nail: 50 femoral shaft fractures followed up for a minimum of 2 years

The results of the first 50 patients who had fractures of the femur treated with a previously reported medullary expanding compression nail are described. The nail is considered ideal for the patient with multiple injuries. Four per cent of the fractures did not unite and the implant failed in 6 per cent.     

Treatment of neglected femoral neck fractures in young adults

Sixteen young adults with neglected femoral neck fractures were treated from 1974 to 1981. The ages ranged from 16 to 43 years. The periods of delay after fracture were three months to two years. Most of the patients were initially treated by a "Chinese bone setter" with subsequent development of leg shortening, upward displacement of the distal fragment, and a variable degree of absorption of the femoral neck or head. Treatment included skeletal traction followed by open or closed reduction, internal fixation, or angulation osteotomy with or without bone graft. Two to eight years later, there were no cases of nonunion. Four hips developed avascular necrosis with one requiring still further surgical treatment. Thirteen patients (81%) had good to excellent results. Preservation of the patients' own hip joints was worthwhile. A defeatist attitude toward the "unsolved" fracture should be qualified.     

Internal fixation of femoral neck fractures in Parkinson's disease 32 patients followed for 2 years

32 patients, suffering from Parkinson's disease, had internal fixation of femoral neck fractures. In 24 displaced fractures, 6 nonunions and 3 segmental collapses were seen; and in 8 undisplaced fractures, 1 case of segmental collapse was diagnosed. Healing complications were thus seen in one third. Total hip replacement for healing complication was performed in 3 of 32 patients. 9 patients died within 2 years. No difference in the rate of healing or mortality was detected compared with hip fracture patients without Parkinson's disease.

Our study does not support primary arthroplasty for femoral neck fracture in patients with Parkinson's disease.     

A report of two cases treated with Pauwels' femoral osteotomy for advanced osteoarthritis resulting from a sequela of infectious coxitis in childhood

Pauwels' femoral valgus osteotomy was performed on two osteoarthritic hips that developed as a sequela of infectious coxitis in the childhood. One of the hips was diagnosed as osteomyelitis of the ipsilateral femur before the operation and was treated with curettage and implantation of antibiotic-impregnated cement beads. The results of both hips were excellent and maintained for 9-11 years.     

Bilateral stress fractures of femoral neck in non-athletes: a report of four cases

Femoral neck stress fractures (FNSFs) are rare,constituting only 5％ of all stress fractures in young adults.These fractures are usually seen in athletes,military recruits and patients with underlying m...     

13例儿童股骨颈骨折手术治疗体会

2006年10月～2009年12月,我院采用手术治疗儿童股骨颈骨折患者共13例,取得满意疗效,报道如下。1材料与方法1.1病例资料本组13例,男8例,女     

23例儿童股骨颈骨折的治疗

[目的]探讨儿童股骨颈骨折治疗方法及疗效。[方法]18例为手法复位，夹板固定并行股骨髁上骨牵引，及髋人字石膏固定；5例切开复位交叉克氏针固定。[结果]随访1～5a 8个月，23例均获愈合，2例发生缺血性坏死。[结论]正确选择治疗方式，早期功能康复指导，对减少其并发症的发生，肢体功能的全面康复有着重要的作用。     

Evaluation of valgus intertrochanteric osteotomy in neglected fracture neck femur in young adults

BackgroundFemoral neck fractures in young adults have always presented a difficult problem with high rates of non-union and avascular necrosis. At our centre we have been using the traditional Pauwels intertrochanteric osteotomy for neglected un-united femoral neck fractures in young adults. We have made certain modifications in this procedure to suit our resources and so we evaluated the outcome of this procedure at our institute.MethodsThe study included fifty consecutive cases of neglected femoral neck fractures treated at our centre between February 1996 and October 2012. Patients in whom internal fixation had failed were excluded. The average age of the patients was 37 years (range: 17–55 years). Eleven of the patients were female & Thirty-nine were male. Fifteen patients belonged to Pauwels grade 1, Twenty-six patients belonged to grade 2, and nine belonged to grade 3. The interval between the injury and operation ranged from 1 to 12months (average: 4.3 months). The cases were operated on a normal table using a Watson Jones Approach. The fracture ends were freshened and fixed using a 6.5mm screw followed by a valgus osteotomy which was fixed by a double angle (120 degree) blade plate.ResultsA fracture union rate of 90% (45 cases) was achieved. Two of the healed cases developed avascular necrosis. Results were graded using Askin and Bryan's criteria. Overall, an excellent result was seen in 35 patients, good in 5, fair in 5 and poor in 5. Of the five patients having poor result (3 non-union, 1 implant breakage, 1 implant cut out), two refused revision surgery. In remaining three, one underwent total hip arthroplasty and in two revision osteotomy was performed.ConclusionWe believe that intertrochanteric osteotomy provides a good outcome for neglected femoral neck fractures. Performing the procedure on a routine table, with Watson Jones approach and fixing with double angle blade plate is a good option.