Role of valgus osteotomy in old fracture neck of femur

Abstract

Background: Nonunion fracture of the neck of the femur remains an unsolved issue owing to peculiar vascular anatomy and the relationship of weight transmission to fracture pattern stability. Salvaging the viable biological head is more preferable than replacement to avoid revision surgeries, especially in young adults. Objective: This study was designed to evaluate the outcome of old fractured necks of femur patients who underwent osteosynthesis through valgus osteotomy. Materials and Methods: We did a retrospective cohort study and collected the data for old fracture neck of the femur from 2010 to 19 from hospital records who underwent valgus osteotomy (McMurray's and Pauwel's osteotomy) and followed them for complications. The Student's t-test was used to compare the results of the two methods, i.e., McMurray's and Pauwel's. Results: About 83.3% of cases were of Pauwel's Type II and III groups. In cases that underwent McMurray's osteotomy, the mean shortening was 0.9 cm. Forty percentage had a full range of movements (ROM), 60% had occasional pain, 20% had complications such as screw back out, trochanteric bursitis, and 10% had avascular necrosis of the head femur. In cases that underwent Pauwel's osteotomy had a mean shortening of 1.5 cm, 20.83% had full ROM, 62.5% had limping, 45.5% had pain, 25% had screw back out, and infection in 25. Two cases underwent trans-fracture abduction osteotomy, so results are not discussed. Conclusions: We found that valgus osteotomy showed promising results and was comparable with the results of acceptable literature. Hence, it is suggested that osteosynthesis rather than arthroplasty should be the preferred method of treatment for old fractures of the neck of the femur.