Valgus Osteotomy versus Arthroplasty for Ununited Femoral Neck Fractures: A Systematic Review

Abstract

F ractures of the neck of femur in young adults tend, unlike their counterparts in older people, to be a relatively higher energy injury and require timely and meticulous diagnosis and management. Anatomical reduction and stable internal fixation are essentials for achieving the goals of treatment in this young population allowing preservation of the femoral head while minimizing rates of non-union and osteonecrosis (1, 41). The evidence on valgus intertrochanteric osteotomy for femoral neck nonunion is limited to retrospective series. Despite some variation in operative technique, the majority of authors report good-to-excellent outcomes with this procedure. Valgus intertrochanteric osteotomy is the treatment of choice for active patients aged less than 50 years with a nonunion of a femoral neck fracture. This technique requires precise preoperative planning and intraoperative skill. Implant selection includes angled blade plates (ABPs), dynamic hip screws (DHS), and dynamic condylar screw (DCS) plates. Union rates approach 90% in most reported series. Patients should be warned of the risk of avascular necrosis, as well as the difficulty in performing revision arthroplasty in this setting (2). The aim of this systematic review is to collate evidence from comparative studies to look for significant differences between valgas osteotomy & arthroplasty in non united femoral neck fractures in<50yr old patients.