Femoral neck nonunion in young patients has always been a difficult problem to deal with for surgeons. Numerous surgical procedures to address either the biological or mechanical issues at the nonunion have been described and most of them have been associated with variable results. Isolated biological augmentation is often associated with poor results and some techniques like vascularized grafting may require not so commonly available expertise. Valgus osteotomy is aimed to correct the abnormal fracture biomechanics associated with femoral neck fractures. By altering the nature of force transmission across the nonunion, shear forces are converted into compressive forces that lead to rapid osseous union without the need for bone grafting. Though the principles are sound and were described a long time ago, the technical aspects have evolved over time. Various modifications have been described to overcome shortcomings such as limb length discrepancy, reduction of femoral offset, alteration in mechanical axis, and the overall proximal femur anatomy. In this review, we look back at the fundamental principles and recent literature on the results of valgus intertrochanteric osteotomy for femoral neck pseudoarthrosis. We also highlight the important need for accurate preoperative planning and surgical execution. Lastly, we elaborate on the technical improvisations that have happened over time in order to improve functional results and to minimize complications and poor outcome after a valgus osteotomy.
Valgus intertrochanteric osteotomy Pseudoarthrosis Femur neck fracture
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The authors declare that they have no conflict of interest.
Swiontkowski MF, Winquist RA, Hansen ST Jr (1984) Fractures of the femoral neck in patients between the ages of twelve and forty-nine years. J Bone Joint Surg Am 66:837–846CrossRefGoogle Scholar
Brandon JY, David WS, David PB, Sean EN (2017) Intertrochanteric osteotomy for femoral neck nonunion: does “undercorrection” result in an acceptable rate of femoral neck union? J Orthop Trauma 31:420–426CrossRefGoogle Scholar
Nagi ON, Dhillon MS, Goni VG (1998) Open reduction, internal fixation and fibular autografting for neglected fracture of the femoral neck. J Bone Joint Surg B 80:798–804CrossRefGoogle Scholar
Otho CH, Bartels WPB, Carl FF (1951) End result study of McMurray osteotomy for acute fractures of the femoral neck. Am J Surg 81(2):215–220CrossRefGoogle Scholar
Pauwels F (1984) Biomechanical principles of varus/valgus intertrochanteric osteotomy (Pauwels I and II) in the treatment of osteoarthitis of the hip. In: Schatzker J (ed) The intertrochanteric osteotomy. Springer, Berlin, HeidelbergGoogle Scholar
Müller ME (1984) Intertrochanteric osteotomy: indication, preoperative planning, technique. In: Schatzker J (ed) The intertrochanteric osteotomy. Springer, Berlin, HeidelbergGoogle Scholar
Deakin DE, Guy P, O’Brien PJ, Blachut PA, Lefaivre KA (2015) Managing failed fixation: valgus osteotomy for femoral neck nonunion. Injury 46(3):492–496CrossRefGoogle Scholar
Kalra M, Anand S (2001) Valgus intertrochanteric osteotomy for neglected femoral neck fractures in young adults. Int Orthop 25(6):363–366CrossRefGoogle Scholar
Wu CC, Shih CH, Chen WJ, Tai CL (1999) Treatment of femoral neck nonunions with a sliding compression screw: comparison with and without subtrochanteric valgus osteotomy. J Trauma 46(2):312–317CrossRefGoogle Scholar
Gupta S, Kukreja S, Singh V (2014) Valgus osteotomy and repositioning and fixation with a dynamic hip screw and a 135 degree single-angled barrel plate for un-united and neglected femoral neck fractures. J Orthop Surg 22(1):13–17CrossRefGoogle Scholar
Khan AQ, Khan MS, Sherwani MK, Agarwal R (2009) Role of valgus osteotomy and fixation with dynamic hip screw and 120 degrees double angle barrel plate in the management of neglected and ununited femoral neck fracture in young patients. J Orthop Traumatol 10(2):71–78. https://doi.org/10.1007/s10195-009-0049-3
Marti RK, Schüller HM, Raaymakers EL (1989) Intertrochanteric osteotomy for non-union of the femoral neck. J Bone Joint Surg Br 71(5):782–787CrossRefGoogle Scholar
Abdelazeem H, Abdelazeem A, Al-Dars A et al (2016) Triple attack technique for nonunion of femoral neck fractures. Int Orthop 40(4):807–812CrossRefGoogle Scholar
Ferguson GM, Cabanela ME, Ilstrup DM (1994) Total hip arthroplasty after failed intertrochanteric osteotomy. J Bone Joint Surg Br 76(2):252–257CrossRefGoogle Scholar
Breusch SJ, Lukoschek M, Thomsen M, Mau H, Ewerbeck V, Aldinger PR (2005) Ten-year results of uncemented hip stems for failed intertrochanteric osteotomy. Arch Orthop Trauma Surg 125(5):304–309CrossRefGoogle Scholar