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Valgus intertrochanteric osteotomy for malunion and nonunion of trochanteric fractures
Jan Bartonícek1, Jirí Skála-Rosenbaum, Pavel Dousa
1Orthopaedic Department, 3rd Faculty of Medicine, Charles University, Prague Srobárova 50 100 34, Prague 10, Czech Republic. bartonic@fnkv.cz
Objective:
To evaluate the results of valgus intertrochanteric osteotomy for varus nonunion and malunion of trochanteric fractures.
Setting:
University hospital.
Design:
Retrospective clinical study.
Patients:
Fifteen patients (age range 29-84 years) with varus malunion (11 cases) or varus nonunion (4 cases). Indication for surgery was nonunion or varus malunion with limb shortening greater than 2 cm associated with limp, abductor muscle insufficiency, hip pain, and back pain.
Intervention:
The patients were treated by a valgus intertrochanteric osteotomy fixed with a 120 degrees double-angled blade plate.
Results:
Average follow-up was 5.5 years (range 2-10 years). Fourteen patients healed without complications: 12 patients within 4 months; 2 delayed unions within 6 months. One patient required revision surgery for a loss of fixation due to a fall 6 weeks after surgery. This osteotomy also healed. Average lengthening achieved by osteotomy was 2 cm (range 1-5 cm). In all patients, the resulting range of flexion in the hip joint was greater than 90 degrees, Harris hip score before surgery was 73 points (range 61-83), and after surgery 92 points (range 76-98). Osteoarthritis or avascular necrosis of the femoral head did not develop in any of the cases.
Conclusion:
Valgus intertrochanteric osteotomy is an effective procedure that reliably restores hip function in trochanteric malunion or nonunion.