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Nonunion is a relatively rare, yet challenging problem after fracture of the femoral neck. Risk factors include verticality of the fracture line and presence of comminution of the posteromedial calcar, as well as quality of reduction. Treatment options consist of valgus intertrochanteric osteotomy versus arthroplasty. Treatment should be tailored t...
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Backgroud:
The osteotomy of the posterolateral overhanging part (PLOP) of the greater trochanter via posterior approach has been used for the hip arthroplasty for decades with good results. However, the osteotomy method remains undefined and the precise adjacent structures around PLOP have not been reported. The purpose of this study was to presen...
Background
Fibrous dysplasia (FD) is a benign neoplasm with a broad spectrum of presentations. The treatment of FD in the hip region is controversial among orthopedic surgeons. Several treatment options exist, including curettage and grafting, valgus osteotomy, medial displacement osteotomy, and so on. Performing total hip arthroplasty (THA) on the...
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Joint-preserving hip operations can help relieve pain and delay the need for long-term joint arthroplasty. Previous research has not identified procedures that can compromise outcomes following total hip arthroplasty (THA). This meta-analysis aims to evaluate the effect of joint-preserving hip operations on outcomes following subsequen...
Introduction: Femoral head fractures are uncommon. A femoral head fracture associated with an ipsilateral neck of femur fracture is classified as a Pipkin’s Type III fracture and is exceedingly rare. It is a high-energy injury associated with an extremely poor prognosis. This has led some authors to advocate primary arthroplasty for these injuries....
Background:
The anterior cortical window technique was developed to facilitate stem removal in revision total hip arthroplasty (THA). In this technique, only the anterior cortex of the proximal femur is osteomized; the trochanter, lateral cortex, and medial cortex remain intact. Therefore, a new stem can be press-fitted into the femur and mediolat...
Citations
... Bone scan scintigraphy was not performed to assess the head vascularity. Malunion or nonunion fracture neck of the femur in the younger population warrants head salvage for restoring normal biomechanics and delaying the need for arthroplasty [14][15][16][17] . ...
Case
An 18-year-old autistic boy with seizure disorder had a 4-month-old hip injury with a similar right hip injury 6 months earlier. X-rays revealed an ununited fracture neck femur on the left and a malunited fracture neck femur on the right hip. Magnetic resonance imaging indicated preserved head vascularity. Valgus osteotomy and double-angle plate fixation of both hips were performed at an interval of 2 months.
Conclusion
Delayed presentation bilateral neck fractures are rare. X-rays showed healed fractures with no avascular necrosis in both hips at 2-year 6-month follow-up. Valgus osteotomy is ideal and relevant for osteosynthesis in selected ununited femur neck fractures.
... In young patients with femoral neck fracture, avascular femoral head necrosis and, more rarely, non-union are among the most feared complications [17,18]. Femoral head necrosis is the most common complication that leads to the implantation of a endoprothesis [7]. ...
Introduction
The purpose of the study was to explore the functional outcome after osteosynthesis with dynamic hip screw (DHS) for adults up to 69 years, and identify potential predictive indicators of either positive impact on quality of life or increase the incidence of complications.
Materials and methods
Out of 85 patients 53 could be contacted, 36 were followed up clinically and radiologically, 17 patients could be interviewed by phone. All fractures have been treated by osteosynthesis with DHS and one additional anti-rotation screw. Functional outcome and quality of life were measured with use of Harris Hip Score (HHS) and Short Form 12 Health Survey (SF 12). The mean values were compared to two random sample t tests and ANOVA for independent random samples. The connection between an aim variable and selected variables of influence was examined by regression analysis.
Results
The mean HHS showed good functional results with 88 points (median 95.6). Good or excellent results were achieved in 80.4% of cases. The current investigation also delivers promising results with regard to the complication rate: avascular femoral head necrosis (AVN) in 11.3% of cases (n = 6), 9.4% showed non-union (n = 5) and cut out (n = 3) occurred in 5.7%. A secondary conversion to hip arthroplasty (n = 7) had a strong negative impact on everyday life (HHS = 63.3 points, Physical Health Summary Score SF-12 = 34.9 points).
Conclusions
The results of this study are promising showing uncomplicated fracture healing in 84.9% of intracapsular femoral neck fractures and a low incidence of complications after osteosynthesis with DHS in patients aged up to 69 years. The quality of the fracture reduction achieved in the axial view and a small tip apex index after an osteosynthetically treated femoral neck fracture with DHS are significant predictive indicators for complications. Diabetes, age > 65 years, osteoporosis, ASA III may also be significant factors for worse results, but showed no statistical significance in our analysis.
... Osteotomy along with Internal Fixation (Wainright plate[17] or Trochanteric hook plate[18]) is superior to McMurray's Osteotomy alone (with post-op hip spica immobilization[19]). The post-op shortening in this study in the cases treated with Modified Pauwel's Osteotomy with internal fixation was statistically compared with Magu et al[20] study article Magu et al found a mean limb length discrepancy of 1.9 cm in a sample size of 8 cases (n = 8). ...
A prospective study (data collected retrospectively from January 2011 to December 2018) was conducted in the department of orthopaedics in SCB Medical College and Hospital from December 2018 to December 2020 on patients with old fracture neck of femur. A total of 42 cases were included for the study who had undergone this surgery before December 2019. Valgus Intertrochanteric Osteotomies included McMurray’s Osteotomy, Modified Pauwel’s Osteotomy and Transfracture Abduction Osteotomy. Thirty six patients were followed up only as Six patients could not be contacted. Valgus Intertrochanteric Osteotomy of proximal femur was found to be the mainstay of the treatment in young patients. Initially Mc Murrays Osteotomy was preferred but in recent times modified Pauwel’s Intertrochanteric Valgus Osteotomy and Trans Fracture Abduction Osteotomy was considered as an augmentation to the healing of a fracture neck of femur which presented late. Keywords: Valgus intertrochanteric osteotomy, Old neck of femur fracture, Fixation
... Beside posttraumatic conditions, non-treated or insufficiently treated congenital conditions or deformities related to childhood diseases may also require corrective osteotomies in adults [8][9][10]25]. However, correction of complex deformities at the proximal femur can be challenging [29][30][31]; wherefore, a detailed preoperative analysis of the deformity and intraoperative subsidies may be useful to achieve the desired deformity correction. The previous literature in the application of 3D planning and the use of PSI in corrective osteotomies at the proximal femur mainly focused on pediatric patients and is lacking the implementation in adults. ...
Background
Corrective osteotomies for complex proximal femoral deformities can be challenging; wherefore, subsidies in preoperative planning and during surgical procedures are considered helpful. Three-dimensional (3D) planning and patient-specific instruments (PSI) are already established in different orthopedic procedures. This study gives an overview on this technique at the proximal femur and proposes a new indirect reduction technique using an angle blade plate.
Methods
Using computed tomography (CT) data, 3D models are generated serving for the preoperative 3D planning. Different guides are used for registration of the planning to the intraoperative situation and to perform the desired osteotomies with the following reduction task. A new valuable tool to perform the correction is the use of a combined osteotomy and implant-positioning guide, with indirect deformity reduction over an angle blade plate.
Results
An overview of the advantages of 3D planning and the use of PSI in complex corrective osteotomies at the proximal femur is provided. Furthermore, a new technique with indirect deformity reduction over an angle blade plate is introduced.
Conclusion
Using 3D planning and PSI for complex corrective osteotomies at the proximal femur can be a useful tool in understanding the individual deformity and performing the aimed deformity reduction. The indirect reduction over the implant is a simple and valuable tool in achieving the desired correction, and concurrently, surgical exposure can be limited to a subvastus approach.
... While the osteotomy is relatively easy to plan and perform, often providing a definitive one-time surgery, the technique of fixation using an angled blade plate is technically challenging as it does not allow for any rotational margin of error. Angled blade plates offer the theoretical advantage of less bony resection of the femoral neck, and less iatrogenic avascular necrosis [16,17]. The use of a sliding hip screw for fixation of the valgus osteotomy has also been described [8]. ...
We report the case of a 36-year-old man, who presented to us five months after the initial trauma. He had been treated elsewhere with a cephalomedullary femoral nail. He described severe pain in his right thigh and groin that confined him to a wheelchair. He had shortening of the right lower limb and painful restriction of movements of the right hip. Radiographs demonstrated hypertrophic callus with a gap at the femoral shaft while the neck fracture was in varus malalignment with bone resorption; the neck fracture been fixed using two hip screws that were missing the nail. The patient was managed with removal of the previous hardware, reamed retrograde nailing and Pauwels' intertrochanteric valgus osteotomy fixed using a 120o double-angled condylar blade plate. Both the fracture sites were not opened. Postoperatively, the femoral shaft showed radiographic evidence of union at three months, while the femoral neck and the intertrochanteric osteotomy site had united at five months. As per the Friedman and Wyman criteria, our patient has a "good" outcome at the four-year follow-up.
... Valgus osteotomy fixation with blade plates has been described in the literature by several authors. [7,[18][19][20] Blade plates have excellent rotational control but are technically difficult to use. Varghese et al. [18] studied 32 patients who developed femoral neck non-unions and were treated using valgus osteotomy and blade-plate fixation. ...
Background
Femoral cervicotrochanteric fracture fixation failure often requires a salvage procedure to preserve the hip. To understand its limitations, this study investigated the use of intertrochanteric osteotomy for this purpose and analyzed causes of failure.
Methods
During 2001 − 2017, 21 patients (males:females = 12:9; 47 ± 17 years) with failed femur cervicotrochanteric fracture fixation were treated with intertrochanteric osteotomy. All patients were followed-up using functional assessment according to the Harris hip score (HHS) and radiological assessment. The clinical end-point was conversion to hip arthroplasty for any reason or acquiring a symptomatic hip with a HHS < 80.
Results
With a follow-up duration of 124 ± 63 months, success was achieved in 16 patients, whereas 5 patients developed fixation failure. Early failure was associated with fixation loss in 2 hips with subcapital fractures, while late failure was related to progression of pre-existing osteonecrosis of the femoral head (ONFH) in 3 hips. Aside from the 2 early failure hips, the osteotomy healed uneventfully in all cases, and the original fracture sites healed within 17.2 ± 6.3 weeks. Of the 5 hips converted to arthroplasty, standard femoral implants were used without the need to re-perform an osteotomy to align the medullary canal. At the final follow-up, significant improvements in limb-length discrepancy (LLD), neck-shaft angle (NSA), and HHS were observed. The valgus osteotomy angle for correction was 21.9° ± 8.4°, and this was maintained at 21.1° ± 10.5° during follow-up.
Conclusions
Intertrochanteric osteotomy is a useful operation and can promote fracture-healing in cases of failed cervicotrochanteric fracture fixation. Subcapital fracture with limited bone to enable secure purchase of the fixation device and pre-existing ONFH were associated with high failure rates. In such cases, salvage should not be attempted using this procedure alone, and arthroplasty or other salvage procedures may be necessary.
... [10,11] Valgus intertrochanteric osteotomy or revision of internal fixation, is reserved for cases with nonunion. [12] Core decompression and hip replacement are reserved for cases complicated with nonunion or in patients who have poor clinical conditions as a result of age or a disease that is affecting bone quality to the degree that can affect healing potential negatively. [13,14] In the hip joint, muscles' contractions during a tonic-clonic seizure or electric shock can lead to peritrochanteric muscle contractions, causing posterior hip dislocation and neck of femur fracture, especially in patients with conditions affecting bone density. ...
... BNOF fractures in young patients induced by muscular spasm following either a seizure episode or electric injury are rare and reported in the literature. [5][6][7][8][9][10][11][12][13][14][15] They typically occur as a result of high-energy trauma in a young, healthy population. [2] The underlying renal disease can affect bone mineral density, quality, tensile stiffness, and remolding potential. ...
Displaced femoral neck fractures (FNF) pose a unique therapeutic challenge for the treating orthopedic surgeon. A mechanically and biologically unfavorable environment leaves little room for error in obtaining an anatomic reduction with stable fixation that can be maintained throughout the duration of healing. Potentially high complication rates including nonunion, malunion, and avascular necrosis warrant thoughtful treatment plans. Outcomes of surgical management are related to time-sensitive surgery, thoughtful fixation, patient compliance, and appropriate surgical indications.
