Valgus Osteotomy and Repositioning and Fixation with a Dynamic Hip Screw and a 135° Single-Angled Barrel Plate for Un-United and Neglected Femoral Neck Fractures

Purpose. To review the outcome of 60 patients who underwent valgus subtrochanteric osteotomy and its repositioning for un-united and neglected femoral neck fractures.Methods. 60 patients (mean age, 35 years) underwent valgus subtrochanteric osteotomy and repositioning of the osteotomy and fixation with a dynamic hip screw and a 135° single-angled barrel plate for closed un-united femoral neck fractures after failed internal fixation (n=27) or neglected (>3 weeks) fractures (n=33). The most common fracture type was transcervical (n=48), followed by subcapital (n=6) and basal (n=6). All patients had displaced femoral neck fractures (Garden types 3 and 4). According to the Pauwel angle, 45 fractures were type 2 (30°–70°) and 15 were type 3 (>70°).Results. Patients were followed up for a mean of 3.5 (range, 2–7.5) years. The mean Pauwel angle of the fracture was corrected from 65° (range, 50°–89°) to 26° (range, 25°–28°). Bone union was achieved in 56 patients after a mean of 3.9 (range, 3–5.5) months. The mean Harris hip score improved from 65 to 87.5. Outcome was excellent in 30 patients, good in 24, and poor in 6. Four of the patients developed avascular necrosis; 2 of whom nonetheless achieved a good outcome.Conclusion. Valgus osteotomy and repositioning and fixation with a dynamic hip screw and a 135° single-angled barrel plate was effective treatment for un-united and neglected femoral neck fractures.