Valgus osteotomy and repositioning and fixation with a dynamic hip screw and a 135° single-angled barrel plate for un-united and neglected femoral neck fractures

Purpose. To review the outcome of 60 patients who underwent valgus subtrochanteric osteotomy and its repositioning for un-united and neglected femoral neck fractures. Methods. 60 patients (mean age, 35 years) underwent valgus subtrochanteric osteotomy and repositioning of the osteotomy and fixation with a dynamic hip screw and a 135 degrees single-angled barrel plate for closed un-united femoral neck fractures after failed internal fixation (n=27) or neglected (>3 weeks) fractures (n=33). The most common fracture type was transcervical (n=48), followed by subcapital (n=6) and basal (n=6). All patients had displaced femoral neck fractures (Garden types 3 and 4). According to the Pauwel angle, 45 fractures were type 2 (30 degrees-70 degrees) and 15 were type 3 (>70 degrees). Results. Patients were followed up for a mean of 3.5 (range, 2-7.5) years. The mean Pauwel angle of the fracture was corrected from 65 degrees (range, 50 degrees-89 degrees) to 26 degrees (range, 25 degrees-28 degrees). Bone union was achieved in 56 patients after a mean of 3.9 (range, 3-5.5) months. The mean Harris hip score improved from 65 to 87.5. Outcome was excellent in 30 patients, good in 24, and poor in 6. Four of the patients developed avascular necrosis; 2 of whom nonetheless achieved a good outcome. Conclusion. Valgus osteotomy and repositioning and fixation with a dynamic hip screw and a 135 degrees singleangled barrel plate was effective treatment for ununited and neglected femoral neck fractures.