Functional and radiological outcome of valgus osteotomy (abduction osteotomy of Pauwel) and fixation with dynamic hip screw in neglected fracture neck of femur

Authors

  • Venugopal S. M. Department of Orthopaedics, BIRRD Trust Hospital, Tirupati, Andhra Pradesh, India
  • Naveen Babu Department of Orthopaedics, BIRRD Trust Hospital, Tirupati, Andhra Pradesh, India
  • Naresh Odnala Department of Orthopaedics, BIRRD Trust Hospital, Tirupati, Andhra Pradesh, India
  • Gudaru Jagadesh Department of Orthopaedics, BIRRD Trust Hospital, Tirupati, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20203504

Keywords:

Abduction osteotomy of Pauwel, Dynamic hip screw, Neglected fracture neck of femur

Abstract

Background: Despite improvements in the techniques of surgery and internal fixation devices, non-union is still reported in one-third of cases of femoral neck fracture with displacement. Valgus intertrochanteric osteotomy alters the biomechanical environment of the fracture site and restores limb length.

Methods: This was a prospective study on functional outcome of valgus osteotomy and fixation with dynamic hip screw (DHS) in neglected fracture neck of femur in Balaji Institute of Surgery, Research and Rehabilitation for the Disabled (BIRRD), Tirupati. 28 patients were enrolled between December 2017 to December 2019. Patients less than 60 years of age with fracture neck of femur of more than or equal to 3 weeks since injury and with failed primary fixation were included. Patients >60 years of age, patients with avascular necrosis (AVN), and with resorption of femoral neck were excluded.

Results: Among 28 patients 12 had union within 6 months and another 12 within 12 months. 4 patients were lost for follow-up hence considered as non-union. Osteotomy site united by 6 months in 22 patients and by 12 months in 2. Harris hip score was fair to excellent in 24 patients and poor in 4.

Conclusions: Valgus osteotomy and DHS fixation is often a definitive one-time surgical procedure to achieve union in neglected and ununited fracture neck femur in young patients. It is simple and biological. In this study because of the delay in presentation and the young age of patients, Pauwels’ osteotomy was performed as the head-salvaging procedure. Union was achieved in 86% of this study patients.

Author Biography

Venugopal S. M., Department of Orthopaedics, BIRRD Trust Hospital, Tirupati, Andhra Pradesh, India

Dr. Venugopal S M , Asssociate Professor, Dept.of Orthopaedics, BIRRD Trust Hospital,T.T.D., 

 Tirupati,

Andhra Pradesh-517501

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Published

2020-08-26

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Original Research Articles