Kulkarni Sunil G, Kulkarni G S, Babhulkar Sushrut, Kulkarni Milind G, Kulkarni Ruta M
Department of Orthopaedics and Trauma, Swasthiyog Pratisthan Fracture and Orthopaedic Hospital, Miraj 416410, India.
Sushrut Institute of Medical Sciences, Research Centre & Post-Graduate Institute of Orthopedics, Nagpur 400010, India.
Injury. 2017 Aug;48 Suppl 2:S2-S7. doi: 10.1016/S0020-1383(17)30486-2.
Non-union of neck femur is a common but difficult situation to manage especially in young adults. There are two main options of arthroplasty or osteotomy. The aim of this study was to assess the results of intertrochanteric valgus osteotomy in non-union femoral neck fractures.
We present a study of 44 cases of neck femur non-union including untreated fractures, late presentations (more than 3 weeks), treated with compression screw, DHS. From 2006-2016, 44 patients presented to our institute and we analyzed them prospectively on the following criteria: Pauwel's angle, Garden classification, union at fracture site, union at osteotomy site, osteoporosis and AVN changes. Inclusion criteria were age<65, neck not reabsorbed, no AVN. Powel's angle was calculated using the anatomic axis of femur. Wedge angle is equal to Powel's angle minus 30 degree. Entry point of DHS was at the base of greater trochanter and tip of the screw was in the inferior quadrant. Y osteotomy was done in the distal half of the lesser trochanter with a proximal straight cut.
Complete union was noted in 93% of the cases. One patient with uncontrolled diabetes developed severe infection and was treated with excision arthoplasty. AVN occurred in 3 cases. The Powell's angle was reduced to mean 30 (22-39). The neck shaft angle was increased to mean 140 (130-150). Limp was noted in almost all patients but they were able to walk full weight bearing with or without the support of a stick.
Valgus intertrochanteric osteotomy achieved good union rates and good functional outcome with minimal complications.
股骨颈骨不连是一种常见但处理困难的情况，尤其在年轻成年人中。主要有两种治疗选择，即关节置换术或截骨术。本研究的目的是评估股骨转子间外翻截骨术治疗股骨颈骨折不连的效果。
我们对44例股骨颈骨不连病例进行了研究，包括未治疗的骨折、延迟就诊（超过3周）以及接受加压螺钉、动力髋螺钉（DHS）治疗的病例。2006年至2016年期间，44例患者到我院就诊，我们依据以下标准对他们进行了前瞻性分析： Pauwel角、Garden分型、骨折部位愈合情况、截骨部位愈合情况、骨质疏松及股骨头缺血性坏死（AVN）变化。纳入标准为年龄<65岁、颈部未吸收、无AVN。Powel角通过股骨解剖轴计算得出。楔形角等于Powel角减去30度。DHS的进针点位于大转子基部，螺钉尖端位于下象限。在小转子远端一半处进行Y形截骨，近端为直切口。
93%的病例实现了完全愈合。1例患有未控制糖尿病的患者发生了严重感染，接受了关节切除成形术治疗。3例出现了AVN。Powel角平均降至30（22 - 39）。颈干角平均增至140（130 - 150）。几乎所有患者都有跛行，但他们能够在有或没有拐杖支撑的情况下完全负重行走。
转子间外翻截骨术实现了良好的愈合率和良好的功能结果，并发症最少。
