Repositioning osteotomy in treatment of nonunited fractures of the femoralneck

ABSTRACT

The aim of the work is to study the results of Pauwels' repositioning subtrochanteric femoral osteotomy in the surgical treatment of nonunion of fracture of the neck of the femur. The total material comprised 14 patients, 8 - 55 years old, mean age 30.2 years. 11 were males and 3 females. The material was subdivided into two age groups Group I of 6 patients who were children and adolescents, aged 5 - 15 years, mean 11.5 years; Group II, adults, 8 patents, aged 27 - 55 years, mean 42.3 years. Treatment was delayed 2 - 13 months, average 4.5 months. The fractures were of Pauwels' Type 2 in 5 cases, and Type 3 in 9. The method used was that of Pauwels. Preoperative Xrays were done. Tracings of those Xrays were used for precision planning of the osteotomy wedge to be removed for valgisation. The method used for preoperative planning in this study was a personal modification of that described by Muller et al in 1979. The rationale was to abolish shear stresses at the fracture line and transform them to compression forces acting across and perpendicular to the fracture line. The osteotomy was internally fixed. Partial weight bearing with crutches was allowed after 3 weeks, and full weight after radiological union of the osteotomy and fracture. Minimum follow-up was for 2 years. The hospital stay was 14-21 days, average 18 days, except in one case who stayed 6 weeks to treat a minor superficial infection. According to Stewart and Wells' criteria of postoperative assessment of the results there were 8 [57.1%], excellent cases, 4 [28.6%] good cases and 2 [14.8%] fair cases. Union of the osteotomy site was within 2 months, The fracture united after 2 - 6 months, average 3.8 months, for the whole material; it was 2.3 months in Group I, and 3.9 months in Group II. Two patients developed avascular necrosis of the femoral head 22 and 24 months after the fracture, and both 11 months after surgery, and the results in both were graded as fair