Date: Wed, 27 Mar 2002 16:52:19 +0500

Subject: Femoral Neck Nonunion

Hello All

A 35 y.o. male was operated in our facility 1.5 years ago. Walked with cane about 8 months, then with full weight-bearing. Hardware failure was revealed this January. The current situation is presented at the attached image. The head looks not deformed and hip ROM is good. Which way should be preferred?

What would be optimal for the case? Osteotomy - McMurray or valgus? Osteosynthesis with core decompression? THR? Something else?.

Best regards,

Alexander N. Chelnokov
Ural Scientific Institute of Traumatology and Orthopaedics
str.Bankovsky, 7. Ekaterinburg 620014 Russia

Reply at: Orthopaedic Trauma Association forum

Date: Wed, 27 Mar 2002 06:26:14 -0700

From: Thomas A. DeCoster

I also have had reasonable success with valgus producing intertrochanteric osteotomy for femoral neck nonunion especially when the neck shaft angle is down to 90 degrees as in these two cases.

Marti RK, Schuller HM Rayymakers ELFB
Intertrochanteric osteotomy for non-union of the femoral neck
JBJS Br 1989;782-787.

50 patients with femoral neck nonunion treated with "Pauwels abduction osteotomy" followed 7 years. 7 (14%) went on to arthroplasty (and these did well despite the osteotomy). Other 43 OK with hip score average 91/100. 21 cases had AVN preop but only 3 went on to arthroplasty.

Also two textbooks

F. Pauwels Biomechanics of the Normal and Diseased Hip
J Schatzker The intertrochanteric osteotomy (Both Springer-Verlag)

Tom DeCoster