Limits...
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.

Show MeSH

Related in: MedlinePlus

Varus nonunion of an intracapsular neck fracture in a 37 year old male. Post operative radiographs showing good union at the nonunion site and at the osteotomy site with restoration of the neck shaft angle.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3643861&req=5

Figure 5: Varus nonunion of an intracapsular neck fracture in a 37 year old male. Post operative radiographs showing good union at the nonunion site and at the osteotomy site with restoration of the neck shaft angle.

Mentions: The average surgical time was 70 minutes {55 – 90 minutes}. The average blood loss was 350 ml {250 – 600 ml}. All fractures united at a mean time of 10 weeks {8 – 13 weeks}. There was no x ray evidence of avascular necrosis at last follow up. The average pre operative Pauwel’s angle was 67 degrees {59–80 degrees} which was corrected to an average of 35 degrees {30–40 degrees}. The average correction in Pauwel’s angle was 32 degrees {22 – 46 degrees}. The mean neck shaft angle in pre operative traction films was 104 degrees {90 – 115 degrees} which was corrected to 136 degrees {130 – 140 degrees} achieving a mean correction of 32 degrees (Figures 5 and 6). The mean Oxford hip score improved from 20 {11 – 24} to 40 {38–42} at one year follow up. There were no screw cut outs, implant failure or loss of correction. There were no incidences of deep infection. 5 patients had clinically demonstrable limb shortening of 0.5 cm or more. None of the patients required a heel raise. 4 patients demonstrated mild trendelenberg lurch at last follow up. All patients resumed their normal activities at an average of 14 weeks and were able to walk unaided at last follow up. The results are summarized in Table 1.


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)

Varus nonunion of an intracapsular neck fracture in a 37 year old male. Post operative radiographs showing good union at the nonunion site and at the osteotomy site with restoration of the neck shaft angle.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Varus nonunion of an intracapsular neck fracture in a 37 year old male. Post operative radiographs showing good union at the nonunion site and at the osteotomy site with restoration of the neck shaft angle.
Mentions: The average surgical time was 70 minutes {55 – 90 minutes}. The average blood loss was 350 ml {250 – 600 ml}. All fractures united at a mean time of 10 weeks {8 – 13 weeks}. There was no x ray evidence of avascular necrosis at last follow up. The average pre operative Pauwel’s angle was 67 degrees {59–80 degrees} which was corrected to an average of 35 degrees {30–40 degrees}. The average correction in Pauwel’s angle was 32 degrees {22 – 46 degrees}. The mean neck shaft angle in pre operative traction films was 104 degrees {90 – 115 degrees} which was corrected to 136 degrees {130 – 140 degrees} achieving a mean correction of 32 degrees (Figures 5 and 6). The mean Oxford hip score improved from 20 {11 – 24} to 40 {38–42} at one year follow up. There were no screw cut outs, implant failure or loss of correction. There were no incidences of deep infection. 5 patients had clinically demonstrable limb shortening of 0.5 cm or more. None of the patients required a heel raise. 4 patients demonstrated mild trendelenberg lurch at last follow up. All patients resumed their normal activities at an average of 14 weeks and were able to walk unaided at last follow up. The results are summarized in Table 1.

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