Fracture neck of femur is one of the commonly encountered injuries in orthopedics. It is more common in elderly individuals. In the 21^st century, there is a significant challenge in the non-union of femur fracture in the field of orthopedics [1]. The fracture of the femur is very common in elderly individuals, however, due to an increase in the high incidence of trauma; there is an increase in the incidence of the fracture of the femur.

The young patient is more likely to present with associated injuries to other parts of the musculoskeletal system, as well as different organ systems. Unfortunately, the link between mechanism and risk of non-union has been difficult to establish, due to heterogeneity in definitions [2,3].

The US Food and Drug Administration thereby defines a “fracture non-union” as a fracture which is at least 9 months old and does not show radiographic evidence of healing for 3 consecutive months. Previous literature has established, however, that healing metrics may be different depending on multiple patients and fracture characteristics, including fracture location.

Diagnosis of a non-union is most commonly established on standard radiography but often confirmed using advanced imaging modalities. Specific work-up as to the primary cause of non-union should be individualized to the particular patient based on history and physical examination [2,4].

Complications associated with fractured neck femur (non-union and avascular necrosis) make this injury all the more important. A femoral neck fracture is usually located intracapsular with synovial fluid bathing the fracture site interferes with the healing process. The femoral neck does not have a periosteal layer; hence the healing is entirely endosteal [5].

Pauwels showed that a higher shearing angle could lead to an unfavorable consolidating process. For this reason, a valgus osteotomy converts shearing into compression forces and increases the fracture healing potential [6]. Valgus intertrochanteric osteotomy alters the biomechanical environment of the fracture site and restores limb length [7,8]. Very few reports have dealt with the results of this procedure internally fixed with a dynamic hip screw and double angle barrel plate.

The present study was done to evaluate the results of valgus osteotomy and fixation of the femur neck fracture in young patients. A total of 32 patients were included in the study. The minimum month for the follow up was 14 months and the maximum up to 42 months. The Harris hip score was evaluated before the start of the surgery and after the end of the surgery. The average raise increased from 65 points to 90 points after the surgery.

In a total of 28 patients, excellent results were obtained, however, in 4 patients the poor result was due to cut – out of implants. None of the patients were lost on follow up, the fracture went on to achieve the satisfactory union after the 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 discrepancy postoperatively was 2.3cm.

No patient had any serious immediate postoperative complications such as deep infection or deep vein thrombosis. No patient had coxa vara, defined as neck-shaft angle less than 120°, and osteotomy site united in all patients at an average time of 10.3weeks (range 8–12weeks). All the patients with united fractures were able to sit cross-legged, squat, and do one-leg stance. Pain and limitation of motion improved remarkably so that the majority of the patients did not have to use crutches at 6months after the operation.

Table-1: Distribution of patients according to results.

It is believed that valgus osteotomy acts as a biological stimulus for the healing of these fractures, promoting osteogenesis as a result of the conversion of shearing forces to compressive forces across the fracture site. The osteotomy is relatively easy to perform, cost-effective provides stability, and often is definitive one-time surgery.

In our present study, because of the delay in intervention and the young age of patients, Pauwels’ osteotomy was performed as the head-salvaging procedure [14]. In the present study, because of the delay in intervention and the young age of patients, Pauwels’ osteotomy was performed as the head-salvaging procedure. Union was achieved in 96.2% of our patients, which is quite good for any surgical intervention.

Among the united fractures, all were able to sit cross-legged, squat, and stand on the affected leg, which is needed in day-to-day life. This also is another advantage over the head-replacing procedure. Marti et al reported that collapse can occur 3–4 years later the following osteotomy. A follow-up period of 3 years in the present study was a limitation in this regard and longer follow-up is required for evaluation of collapse in the femoral head.

One disadvantage of repositioning valgus osteotomies is that valgisation of the proximal femur shortens the lever arm and alters the hip biomechanics, thus increasing contact pressure on the femoral head. This may increase the risk of osteoarthrosis and avascular necrosis.

From the study, it was concluded that valgus osteotomy and fixation with dynamic hip screw and 120° double angle barrel plate has a high success rate in young patients with neglected and ununited intracapsular fracture neck of femur.

Valgus osteotomy at the subtrochanteric level and repositioning of the osteotomy is an effective treatment for un-united and neglected femoral neck fractures.

Dr. Chetan L Rathod: Formulated the aims and