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Intertrochanteric osteotomy for non-union of the femoral neck
R K Marti1, H M Schüller, E L Raaymakers
1Department of Orthopaedic Surgery, University of Amsterdam, The Netherlands.
Insights
Pauwels abduction osteotomy effectively treats ununited femoral neck fractures in active patients under 70. This procedure yields good results, even with avascular necrosis, and allows for future prosthetic replacement if needed.
Area of Science:
- Orthopedic Surgery
- Traumatology
- Hip Surgery
Background:
- Ununited femoral neck fractures present a significant challenge in active patients.
- Previous treatments have variable success rates and complications.
- Pauwels abduction osteotomy is a potential surgical solution.
Purpose of the Study:
- To evaluate the efficacy of Pauwels abduction osteotomy for treating ununited femoral neck fractures.
- To assess functional outcomes and complication rates in a cohort of patients.
- To determine the long-term viability of this surgical approach.
Main Methods:
- A retrospective review of 50 patients under 70 years old with ununited femoral neck fractures.
- Treatment involved Pauwels abduction osteotomy.
- Patients were followed for an average of 7.1 years, with detailed assessment of 37 cases.
Main Results:
- An average Harris hip score of 91 was achieved in the reviewed patients.
- Seven patients (14%) required subsequent prosthetic replacement.
- Avascular femoral head necrosis was observed in 22 hips (44%), but only 3 required replacement.
Conclusions:
- Pauwels osteotomy offers a high rate of successful outcomes for active patients with ununited femoral neck fractures.
- The procedure remains effective even in the presence of avascular necrosis, provided no collapse has occurred.
- Prosthetic replacement is a viable option if the osteotomy fails, preserving future treatment possibilities.
Abstract:
We report a series of 50 patients under 70 years of age who had an ununited femoral neck fracture treated by a Pauwels abduction osteotomy. At an average follow-up of 7.1 years, seven patients had required prosthetic replacement and 37 others were reviewed in detail. In these patients the Harris hip score averaged 91. Twenty-two hips showed radiographic evidence of avascular femoral head necrosis, but only three of these had been replaced. For active patients with non-union of a femoral neck fracture, Pauwels osteotomy provides a high proportion of good results even in the presence of avascular necrosis of the head, providing there has been no collapse. If osteotomy fails, prosthetic replacement is still possible.