Experience of valgus osteotomy for neglected and failed osteosynthesis in fractures neck of femur

  • Jatin PrakashEmail author
  • Vikas Keshari
  • Rajesh Kumar Chopra
Original Paper



There is vast literature supporting valgus osteotomy in fracture neck of femur. However, little or no distinction has ever been made to evaluate the success of the procedure in these two different scenarios—non-unions due to failed osteosynthesis and neglected fractures neck of femur. The aim of our study was to compare the results of valgus osteotomy in neglected neck femur fractures and non-union fractures of neck of femur.


This is a single tertiary centre-based retrospective study. The records of all patients aged less than 45 years who underwent valgus osteotomy for neck of femur fractures from 2012 to 2017 were evaluated. Patients with fracture neck of femur of over one month’s duration, where no previous surgical intervention was undertaken were placed in neglected fracture group. Patients with failed primary osteosynthesis surgery, either cannulated cancellous screw or dynamic hip screw, were placed in fixation failure group. There were 23 patients in neglected group and 17 patients in fixation failure group. Demographical details, fracture patterns, and preoperative radiograph, surgery time, blood loss, post-operative complications, union time, and non-unions were studied in both groups.


Osteotomy site united in mean time of 11 weeks in fixation failure group and 11.3 weeks in neglected group (p = .434). Time to radiological union of fracture was 16 weeks (12–23 weeks) for neglected fracture group compared to 25 weeks (20–32 weeks) for fixation failure group which was statistically significant (p = .02). Seven out of 17 fractures did not unite in fixation failure group compared to one non-union out of 23 patients in neglected group. (p = .004) There were two loss of fixation with implant failure in fixation failure group compared to none in neglected group (p = .174). Neither of the groups had any surgical site infection.


Valgus osteotomy results in excellent union rates for neglected fractures of neck of femur. However, the union rates of valgus osteotomy are lower in neck femur fractures with failed implants compared to neglected fractures and the procedure should be cautiously used in such circumstances.


Valgus osteotomy Neglected Non-union Neck of femur fracture 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Sharma M, Sood LK, Kanojia RK, Sud A (2004) Valgus osteotomy for nonunion fracture neck femur. Indian J Orthop 38:88–91 Google Scholar
  2. 2.
    Huang CH (1986) Treatment of neglected femoral neck fracture in young adults. Clin Orthop 206:117–126Google Scholar
  3. 3.
    Leung PC, Shen WY (1993) Fracture of the femoral neck in younger adults. A new method of treatment for delayed and nonunions. Clin Orthop (295):156–160Google Scholar
  4. 4.
    Varghese VD, Livingston A, Boopalan PR, Jepegnanam (2016) TS. Valgus osteotomy for nonunion and neglected neck of femur fractures. World J Orthop 7(5):301–307. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Pauwels F (1980) Biomechanics of the locomotor apparatus. Springer Verlag, New YorkCrossRefGoogle Scholar
  6. 6.
    Muller ME (1984) Intertrochanteric osteotomy: indications, preoperative planning, technique. Springer-Verlag, Berlin, pp 25–66CrossRefGoogle Scholar
  7. 7.
    Deakin DE, Guy P, O’Brien PJ, Blachut PA, Lefaivre KA (2015) Managing failed fixation: valgus osteotomy for femoral neck nonunion. Injury. 46:492–496CrossRefGoogle Scholar
  8. 8.
    Ferguson G, Cabanela M, Ilstrup D (1994) Total hip arthroplasty after failed intertrochanteric osteotomy. J Bone Joint Surg (British Volume) 76-B(2):252–257CrossRefGoogle Scholar
  9. 9.
    Iwase T, Hasegawa Y, Iwasada S, Kitamura S, Iwata H (1999) Total hip arthroplasty after failed intertrochanteric valgus osteotomy for advanced osteoarthrosis. Clinical Orthopaedics and Related Research, no 364:175–181CrossRefGoogle Scholar
  10. 10.
    Garden RS (1961) Low angle fixation in fractures of femoral neck. J Bone Joint Surg (Br) 43:647–663CrossRefGoogle Scholar
  11. 11.
    Kofoed H, Alberts A (1980) Femoral neck fractures. Acta Orthop Scand 51:127–136CrossRefGoogle Scholar
  12. 12.
    Khan AQ, Khan MS, Sherwani MK, Agarwal R (2009) Role of valgus osteotomy and fixation with dynamic hip screw and 120 degrees double angle barrel plate in the management of neglected and ununited femoral neck fracture in young patients. J Orthop Traumatol 10(2):71–78. CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Meyers MH, Harvy JP Jr, Moore TM (1933) Treatment of displaced subcapital and transcervical fracture of femoral neck by muscle pedicle bone graft and internal fixation. J Bone Joint Surg (Am) 55:257–274CrossRefGoogle Scholar
  14. 14.
    Kalra M, Anand S (2001) Valgus intertrochanteric osteotomy for neglected femoral neck fractures in young adults. Int Orthop 25(6):363–366CrossRefGoogle Scholar
  15. 15.
    Gavaskar AS, Srinivasan P, Jeyakumar B, Raj RV (2019) Valgus intertrochanteric osteotomy for femur neck pseudoarthrosis: a simple solution to a complex problem that has stood the test of time. Int Orthop (2019 Jun 14).
  16. 16.
    Anglen JO (1997) Intertrochanteric osteotomy for failed internal fixation of femoral neck fractures. Clin Orthop. Aug (341):175–182Google Scholar
  17. 17.
    Marti RK, Schüller HM, Raaymakers EL (1989) Intertrochanteric osteotomy for non-union of the femoral neck. J Bone Joint Surg Br 71(5):782–787CrossRefGoogle Scholar
  18. 18.
    Barrack RL, Rosenberg AG (2006) The hip (2nd edition). Lippincott Williams & Wilkins, Philadelphia. ISBN: 0-7817-4634-5. Pg: 107 – 123Google Scholar
  19. 19.
    Gavaskar AS, Chowdary NT (2013) Valgus sliding subtrochanteric osteotomy for neglected fractures of the proximal femur; surgical technique and a retrospective case series. J Orthop Surg Res 8:4CrossRefGoogle Scholar
  20. 20.
    Magu NK, Singla R, Rohilla R, Gogna P, Mukhopadhyay R, Singh A (2014) Modified Pauwels’ intertrochanteric osteotomy in the management of nonunion of a femoral neck fracture following failed osteosynthesis. The Bone & Joint Journal 96-B(9):1198–1201CrossRefGoogle Scholar
  21. 21.
    Abdelazeem H, Abdelazeem A, Al-Dars A, Hegazy M, Abdellatif N (2016) Triple attack technique for non-union of femoral neck fractures. Int Orthop 40(4):807–812. CrossRefPubMedGoogle Scholar
  22. 22.
    Sandhu HS, Sandhu PS, Kapoor A (2005) Neglected fractured neck of the femur: a predictive classification and treatment by osteosynthesis. Clin Orthop Relat Res (431):14–20Google Scholar
  23. 23.
    Magu NK, Magu S, Rohilla RK, Batra A, Jaipuria A, Singh A (2014) Computed tomographic evaluation of the proximal femur: a predictive classification in displaced femoral neck fracture management. Indian J Orthop 48:476–483CrossRefGoogle Scholar
  24. 24.
    Wroblewski BM, Siney PD, Fleming PA, Charnley (2009) Low-frictional torque arthroplasty: follow-up for 30 to 40 years. J Bone Joint Surg Br 91:447–450CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2019

Authors and Affiliations

  • Jatin Prakash
    • 1
    Email author
  • Vikas Keshari
    • 1
  • Rajesh Kumar Chopra
    • 1
  1. 1.Central institute of Orthopaedics, VardhmanMahavir Medical College and Safdarjang HospitalNew DelhiIndia

Personalised recommendations