Valgus osteotomy for nonunion and neglected neck of femur fractures

• 作者: Abel Livingston P R Boopalan Thilak S Jepegnanam Viju Daniel Varghese
• 来源期刊: 世界骨科杂志
• 学科: 医学
• 关键词: NECK of FEMUR VALGUS INTERTROCHANTERIC osteotomy Head shaft angle NECK RESORPTION ratio NONUNION
• 年，卷（期）: sjgkzzywb_2016,（5）
• 页码范围: 301-307
• 页数: 7页
• 分类号: R

摘要

Nonunion neck of femur can be a difficult problem to treat,particularly in the young,and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics.The various treatment options that have been described can be broadly divided according to the aim of improving either biology or biomechanics.Surgeries aimed at improving the biology,such as vascularized fibula grafting,have good success rates but require high levels of expertise and substantial resources.A popular surgical treatment aimed at improving the biomechanics-valgus intertrochanteric osteotomyoptimizes conditions for fracture healing by converting shear forces across the fracture site into compressive forces.Numerous variations of this surgical procedure have been developed and successfully applied in clinical practice.As a result,the proximal femoral orientation for obtaining a good functional outcome has evolved over the years,and the present concept of altering the proximal femoral anatomy as little as possible has arisen.This technical objective supports attaining union as well as a good functional outcome,since excessive valgus can lead to increased joint reaction forces.This review summarizes the historical and current literature on valgus intertrochanteric osteotomy treatment of nonunion neck of femur,with a focus on factors predictive of good functional outcome and potential pitfalls to be avoided as well as controversies surrounding this procedure.