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.

ABSTRACT

BACKGROUND: Head preservation is the mainstay of management in younger patients with neglected or ununited intracapsular fracture neck of femur. Very few reports have dealt with the results of valgus intertrochanteric osteotomy and fixation with dynamic hip screw in such cases. In this prospective study, we have tried to evaluate the role of valgus osteotomy and fixation with dynamic hip screw and 120 degrees double angle barrel plate in neglected or ununited intracapsular fracture neck of femur in patients below 60 years of age and whose time since injury is equal to or more than 3 weeks. MATERIALS AND METHODS: We treated 16 such cases with valgus intertrochanteric osteotomy and fixation achieved with dynamic hip screw and 120 degrees double angle barrel plate, with mean age of 36.4 years. The cases were evaluated radiologically and clinically at a mean of 19 months. RESULTS: In 14 of the 16 patients, the fracture went on to satisfactory union after an average of 14.7 weeks (10-26.7 weeks). The average Harris hip score increased from 66.6 points (range 55-75 points) before surgery to 88 points (range 75-95 points). All the patients with united fractures were able to sit cross-legged, squat and do one-leg stance. Pain and limitation of motion improved remarkably. Two patients had unfavourable outcome; both had cut-through of the implant, out of the head. CONCLUSIONS: Valgus intertrochanteric osteotomy is a very cheap and effective procedure to achieve union in neglected and ununited fracture neck femur in young patients. We propose fixation with dynamic hip screw and 120 degrees double angle barrel plate as it provides additional compression and, with valgus osteotomy, improved stability of internal fixation, with few complications.