Non-wedge Technique for Valgus Subtrochanteric Osteotomy in Pediatric Femoral Neck Non-union
Asian Journal of Orthopaedic Research,
Page 10-16
Abstract
Aims: The aim of this retrospective study was to evaluate the clinical and radiological outcomes of using valgus subtrochanteric osteotomy in pediatric femoral neck non-union in terms of Ratliff functional score and time to union respectively.
Study Design: Case Series.
Place and Duration of Study: Ghurki Trust Teaching Hospital Lahore Pakistan. Study conducted between Jan 2016 to Dec 2019.
Methodology: This was a retrospective study of 5 children with femoral neck non-union who underwent osteosynthesis and valgus subtrochanteric osteotomy at Ghurki Trust Teaching hospital between 2016 and 2019. Clinico-demographic profile of patients and functional and radiological outcomes in terms of Ratliff grading and time to union respectively are reported. All patients had a minimum of 2 years followup.
Results: This study included five patients (two males and three females with mean age of 9.8 ± 1.92 years). All patients achieved fracture union, seen within an average of 18 ±6.37 weeks and of the osteotomy site within 13 ± 2.9 weeks. Neck shaft angle improved from average 107 degrees (range 100-110) preoperatively to 137 degrees postoperatively (range 130-140). Pre-operative radiologic signs of AVN was shown in all patients which disappeared completely in 4 patients. Mean limb-length discrepancy decreased from 2.9 cm preoperatively to 0.8 ± 0.57cm post-operatively. According to Ratliff criteria, 4patients had good whereas one patient had fair functional outcome. There were no intra-operative or early post-operative complications recorded in our series.
Conclusion: We report that valgus subtrochanteric osteotomy in non-united femoral neck fractures in children is cost-effective and technically less demanding procedure and is associated with good clinical and radiological outcomes.
Keywords:
- Neck of femur fracture
- non-union
- valgus subtrochanteric osteotomy
- pediatric
- Pakistan
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References
Sanghavi S, Patwardhan S, Shyam A, Nagda T, Naik P. Nonunion in pediatric femoral neck fractures. The Journal of Bone and Joint Surgery American Volume. 2020;102(11):1000-10.
Elgeidi A, El-Negery A. Fibular strut graft for nonunited femoral neck fractures in children. Journal of Children's Orthopaedics. 2017;11(1):28-35.
Magu NK, Singh R, Sharma AK, Ummat V. Modified Pauwels' intertrochanteric osteotomy in neglected femoral neck fractures in children: a report of 10 cases followed for a minimum of 5 years. Journal of Orthopaedic Trauma. 2007;21(4):237-43.
Neto PF, Dos Reis FB, Filho JL, Fernandes HJ, Fujiki EN, Bensahel H, et al. Nonunion of fractures of the femoral neck in children. Journal of Children's Orthopaedics. 2008;2(2):97-103.
Sharma A, Tiwari A, Verma T, Maini L. Non-union fracture neck femur in a toddler: Reconstructed by valgus osteotomy - A minimally invasive approach. Journal of Clinical Orthopaedics and Trauma. 2016; 7(Suppl 1):8-11.
Khan AQ, Khan MS, Sherwani MK, Agarwal R. 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. Journal of Orthopaedics and Traumatology: Official Journal of the Italian Society of Orthopaedics and Traumatology. 2009;10(2):71-8.
Togrul E, Bayram H, Gulsen M, Kalaci A, Ozbarlas S. Fractures of the femoral neck in children: long-term follow-up in 62 hip fractures. Injury. 2005;36(1):123-30.
Shrader MW, Jacofsky DJ, Stans AA, Shaughnessy WJ, Haidukewych GJ. Femoral neck fractures in pediatric patients: 30 years experience at a level 1 trauma center. Clinical Orthopaedics and Related Research. 2007;454:169-73.
Ratliff AH. Traumatic separation of the upper femoral epiphysis in young children. The Journal of bone and joint surgery British Volume. 1968;50(4):757-70.
Ratliff AH. Fractures of the neck of the femur in children. The Journal of bone and joint surgery British Volume. 1962;44-b:528-42.
Azam MQ, Iraqi A, Sherwani M, Abbas M, Alam A, Sabir AB, et al. Delayed fixation of displaced type II and III pediatric femoral neck fractures. Indian Journal of Orthopaedics. 2009;43(3):253-8.
Ju L, Jiang B, Lou Y, Zheng P. Delayed treatment of femoral neck fractures in 58 children: open reduction internal fixation versus closed reduction internal fixation. Journal of Pediatric Orthopedics Part B. 2016;25(5):459-65.
Varshney MK, Kumar A, Khan SA, Rastogi S. Functional and radiological outcome after delayed fixation of femoral neck fractures in pediatric patients. Journal of Orthopaedics and Traumatology : Official Journal of the Italian Society of Orthopaedics and Traumatology. 2009; 10(4):211-6.
Magu NK, Rohilla R, Singh R, Tater R. Modified pauwels' intertrochanteric osteotomy in neglected femoral neck fracture. Clinical Orthopaedics and Related Research. 2009;467(4):1064-73.
Mittal R, Banerjee S. Proximal femoral fractures: Principles of management and review of literature. Journal of Clinical Orthopaedics and Trauma. 2012;3(1):15-23.
Jaiswal A, Pruthi KK, Goyal RK, Pathak V, Habib M, Tanwar YS, et al. Evaluation of osteosynthesis with dual fibular bone grafting for neglected femoral neck fractures. Journal of Clinical Orthopaedics and Trauma. 2013;4(2):58-69.
Patterson JT, Tangtiphaiboontana J, Pandya NK. Management of pediatric femoral neck fracture. The Journal of the American Academy of Orthopaedic Surgeons. 2018;26(12):411-9.
Chládek P, Trc T. Fractures of the femoral neck in children: complications and their treatment. Acta chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca. 2002; 69(1):31-4.
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