Treatment of non-united femoral neck fracture by a novel subtrochanteric angulation lateral translation valgus osteotomy (SALVA osteotomy).

PURPOSE: The ideal treatment of non-united and neglected fracture neck femur in the young adult still remains unclear and is characterized by many biological and biomechanical challenges. METHODS: Twenty-one patients with non-united or neglected fracture neck femur aged between 19 and 50 years were treated by a novel subtrochanteric valgus osteotomy and were followed up for a mean of 26.7 months. Patients were assessed by radiological parameters, the Harris Hip Score, Oxford Knee Score, and Askin Bryan Criteria to categorize the overall outcome of the patients at 24 months. Other outcome measures included the occurrence of AVN, adductor lever arm, leg length discrepancy, and mechanical implant failure. RESULTS: All patients treated with the SALVA osteotomy consolidated and displayed a marked improvement of functional and radiological outcome measures. Nevertheless, there were 2 mechanical failures in patients with marked osteopenia and three developed AVN. CONCLUSIONS: In patients with un-united/neglected fracture neck femur, SALVA osteotomy appears to be reliable and reproducible. It also restores the abductor lever arm and improves the leg length discrepancy. Technically less demanding conversion to arthroplasty remains still possible prospectively.

Closed reduction with or without adductor tenotomy for developmental dysplasia of the hip presenting at walking age.

BACKGROUND: Many children with developmental dislocation of the hip especially in underdeveloped countries reach walking age and still remain undiagnosed, which can be detrimental to their growth and development. Because of the lack medical services often encountered in these regions, it would be attractive to find a cheap and effective treatment. Our work evaluated the results of treatment of these children by closed reduction with or without adductor tenotomy in a prospective study. METHODS: We included 20 patients in this study with 29 affected hips (15 right and 14 left). Nine patients (45%) had bilateral DDH and 11 (55%) had unilateral DDH. There were 18 girls (90%) and two boys (10%) who were followed up for a mean of 21 mo (18-24 mo). Ages ranged from 9 to 36 mo (mean age 18.3 mo). Patients were divided according to age into two groups: between 9-18 mo and from 19-36 mo. The first group included nine patients (14 hips) while the second had 11 patients (15 hips). RESULTS: In the first group, closed reduction failed in two patients (two hips) during the follow-up period (14.3%) and this necessitated shift to open reduction, while in the second group only one patient (bilateral DDH) had a similar failure (13.3%). We identified four hips with avascular necrosis. Three of them required no further treatment, the remaining hip was openly reduced. CONCLUSIONS: Closed reduction in older children offers a valid and reproducible treatment modality in the hands of an experienced pediatric orthopaedic surgeon as long as there is close follow-up and thorough knowledge of possible complications and their management including the ability to shift timely to open reduction.