VALGUS INTERTROCHANTERIC OSTEOTOMY USING DYNAMIC HIP SCREW FOR NEGLECTED NON-UNION OF NECK OF FEMUR FRACTURE IN A MIDDLE AGED MALE-A CASE REPORT.

Abstract

Neck of femur fracture is a common orthopaedic problem. The management of the non union of the neck of femur is challenging because of the biological and the mechanical factors at play. Osteosynthesis is the modality of choice for the people aged 60 years or less while arthroplasty is the treatment offered for the older age group. Numerous techniques have been described for the osteosynthesis of the non union of neck of femur. The main principle of all these methods remains optimization of the biology and mechanics of the fracture to promote fracture union and delay the onset of hip arthritis. Here we describe a case of a young middle aged male who due to ongoing COVID-19 pandemic and the imposed lockdowns was not able to receive proper healthcare. He presented to us with 9 months duration of nonunion of right neck of femur fracture. Radiographs were obtained which revealed a Pauwels type 3 fracture and a Sandhu class 2 nonunion. MRI studies were done to ascertain the viability of the femoral head. After all the investigations, a decision was taken to attempt head salvage using a Valgus intertrochanteric Osteotomy. Careful preoperative assessment and calculations were done to accurately determine the osteotomy wedge, DHS pin insertion angle and the goal Pauwels angle. It was decided to correct the Pauwels angle to 30° to reduce shear forces at the fracture site and achieve compression at the fracture site. After the surgical procedure patient was followed up and the fracture as well the osteotomy site showed the signs of union at 24 weeks post operative. Patient achieved excellent function in his hip. He was able to walk pain and limp free, he could squat, sit crosslegged and perform his day to day activites as well as his ground level activites. His post operative Harris Hip Score was 90.8(excellent) at 24 weeks follow up. We thus conclude that a carefully planned valgus intertrochanteric osteotomy is able to achieve excellent outcomes in young patients with non union of neck of femur.