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Valgus sliding subtrochanteric osteotomy for neglected fractures of the proximal femur; surgical technique and a retrospective case series.

Gavaskar AS, Chowdary NT - J Orthop Surg Res (2013)

Bottom Line: There were significant improvements in the postoperative Pauwel's angle, neck shaft angle and Oxford hip score.There was no x ray evidence of avascular necrosis of the femoral head at one year follow-up.The sliding osteotomy technique is simple, does not need extensive pre operative planning or removal of bone from the proximal femur.

View Article: PubMed Central - HTML - PubMed

Affiliation: Dept of Trauma, Parvathy Hospital, Chennai, India. gavaskar.ortho@gmail.com

ABSTRACT

Background: Conventional technique of valgus osteotomy of the proximal femur involves removal of a partial or full thickness lateral based wedge from the peritrochanteric region. The purpose of this article is to describe a novel technique of valgus subtrochanteric osteotomy for proximal femur nonunion.

Methods: 11 patients with proximal femur nonunions {intracapsular fractures--7, extracapsular fractures--4} were treated using a new technique of sliding subtrochanteric osteotomy and DHS fixation. Outcomes analysed include radiological outcome in terms of improvement in Pauwel's angle, neck-shaft angle and evidence of radiological union at the nonunion site and osteotomy site. Other outcomes analysed include, measurement of limb length discrepancy and functional outcome assessment with Oxford hip score.

Results: Union at the nonunion site and the osteotomy site was achieved in all patients. There were significant improvements in the postoperative Pauwel's angle, neck shaft angle and Oxford hip score. Limb length discrepancy improved to less than 1 cm in all patients. There was no x ray evidence of avascular necrosis of the femoral head at one year follow-up.

Conclusions: The sliding osteotomy technique is simple, does not need extensive pre operative planning or removal of bone from the proximal femur.

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Related in: MedlinePlus

The derotation screw and the Richard’s screw are inserted along the axis of the femoral neck achieved on traction.
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Figure 1: The derotation screw and the Richard’s screw are inserted along the axis of the femoral neck achieved on traction.

Mentions: The 2.5 mm guide wire for the Richard’s screw was inserted such that it lies in the lower half of the femoral neck in AP view and in the center of the femoral neck in lateral view (Figure 1). The guide wire was inserted along the axis of the femoral neck that has been achieved with traction. After confirming the position of the guide wire in two planes, another 2.5 mm guide wire was passed superiorly to the first wire. A 6.5 mm partially threaded cancellous screw with a washer was inserted over the superior guide wire to prevent the head fragment from rotating during DHS insertion. The track for the DHS lag screw was created with a triple reamer and an appropriately sized lag screw was inserted.


Valgus sliding subtrochanteric osteotomy for neglected fractures of the proximal femur; surgical technique and a retrospective case series.

Gavaskar AS, Chowdary NT - J Orthop Surg Res (2013)

The derotation screw and the Richard’s screw are inserted along the axis of the femoral neck achieved on traction.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3643861&req=5

Figure 1: The derotation screw and the Richard’s screw are inserted along the axis of the femoral neck achieved on traction.
Mentions: The 2.5 mm guide wire for the Richard’s screw was inserted such that it lies in the lower half of the femoral neck in AP view and in the center of the femoral neck in lateral view (Figure 1). The guide wire was inserted along the axis of the femoral neck that has been achieved with traction. After confirming the position of the guide wire in two planes, another 2.5 mm guide wire was passed superiorly to the first wire. A 6.5 mm partially threaded cancellous screw with a washer was inserted over the superior guide wire to prevent the head fragment from rotating during DHS insertion. The track for the DHS lag screw was created with a triple reamer and an appropriately sized lag screw was inserted.

Bottom Line: There were significant improvements in the postoperative Pauwel's angle, neck shaft angle and Oxford hip score.There was no x ray evidence of avascular necrosis of the femoral head at one year follow-up.The sliding osteotomy technique is simple, does not need extensive pre operative planning or removal of bone from the proximal femur.

View Article: PubMed Central - HTML - PubMed

Affiliation: Dept of Trauma, Parvathy Hospital, Chennai, India. gavaskar.ortho@gmail.com

ABSTRACT

Background: Conventional technique of valgus osteotomy of the proximal femur involves removal of a partial or full thickness lateral based wedge from the peritrochanteric region. The purpose of this article is to describe a novel technique of valgus subtrochanteric osteotomy for proximal femur nonunion.

Methods: 11 patients with proximal femur nonunions {intracapsular fractures--7, extracapsular fractures--4} were treated using a new technique of sliding subtrochanteric osteotomy and DHS fixation. Outcomes analysed include radiological outcome in terms of improvement in Pauwel's angle, neck-shaft angle and evidence of radiological union at the nonunion site and osteotomy site. Other outcomes analysed include, measurement of limb length discrepancy and functional outcome assessment with Oxford hip score.

Results: Union at the nonunion site and the osteotomy site was achieved in all patients. There were significant improvements in the postoperative Pauwel's angle, neck shaft angle and Oxford hip score. Limb length discrepancy improved to less than 1 cm in all patients. There was no x ray evidence of avascular necrosis of the femoral head at one year follow-up.

Conclusions: The sliding osteotomy technique is simple, does not need extensive pre operative planning or removal of bone from the proximal femur.

Show MeSH
Related in: MedlinePlus