Valgus intertrochanteric osteotomy and fibular strut graft in the management of neglected femoral neck fracture

Purpose: A prospective study of neglected femoral neck fractures in mostly young patients was conducted to evaluate whether our technique of valgus intertrochanteric osteotomy with fibular strut grafting and osteosynthesis with dynamic hip screw and double-angle side plate can facilitate union with consistent satisfactory clinical outcomes. Methods: Forty-one consecutive patients (27 males, 14 females) of neglected femoral neck fractures treated between April 2002 and December 2009 were studied. The average age of patients was 45.41 years (+/- 11.67, range 20-62 years). The average interval since injury was 14 weeks (+/- 10.21, range 4-44 weeks). The cases were evaluated radiographically and clinically. Results: The average follow-up period was 32.5 months (+/- 8, range 24-54 months). Radiographically union was seen in 39 patients at the nonunion site. The average time to radiographic union was 16.82 weeks (+/- 3 weeks, range 12-24 weeks). Average Harris Hip Score (HHS) was 19.9 (+/- 7.9, range 10-35) preoperatively and 90.9 (+/- 10.35, range 62-100) at the latest follow-up. At that time clinical outcomes were excellent in 31, good in four, fair in three and poor in three patients. Conclusion: Our mechanobiological surgical technique is reproducible with radiographic union achieved in 95.12% cases (39 patients) at the nonunion site and consistent excellent or good functional outcome in 85% of patients over a 32-month average follow-up. We recommend this procedure for neglected femoral neck fractures. (C) 2012 Elsevier Ltd. All rights reserved.