Management of Old Neck Femur Fracture through Valgus Osteotomy and Pin Fixation

Abstract

Introduction: Valgus intertrochanteric osteotomy alters the biomechanical environment of the fracture site and restores limb length. Very few reports have dealt with the results of this procedure internally fixed with a dynamic hip screw and double angle barrel plate. Hence, the prospective study was performed at the institution level for the evaluation of results of valgus osteotomy and fixation of the femur neck fracture in young patients.

Material and Methods: A total of 32 patients were included in the study. There were 24 males and 8 females in the study. Before osteotomy, the average neck-shaft angle was 101° (80–120°), with an average limb shortening of 2.3 cm (1.0–3.2 cm). The greater trochanter was up riding in fourteen cases and needed skeletal traction before surgery. None of these had evidence of vascular necrosis on plain radiograph or MRI. The fractures were treated with a dynamic hip screw and double angle barrel plate. The patients had a minimum follow-up of 14 months and a maximum of 42 months.

Results: In a total of 28 patients the 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 2.3 cm.

Conclusion: 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 the femur as far as the union of fracture is concerned.