Closing lateral wedge valgus osteotomy with dynamic hip screw for the treatment of varus nonunion of pertrochanteric fracture

Can restoration of biomechanics and stabilization alone heal?

S. Vidyadhara, Sharath K. Rao, S. Pandian, James Gnanadoss

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Introduction: Nonunion of pertrochanteric fracture is rare and its occurrence especially without prior surgical intervention has been hardly ever reported. Hence there is not much literature describing the best way to treat them. Nonunion of pertrochanteric fracture collapses in to varus by virtue of deforming action of muscles and thus deranging the biomechanics of the hip and indirectly preventing fracture union further. Hence it is very important to re-orient the abductor lever arm to biomechanically advantageous normal conWguration favoring fracture healing. In general, principles of treatment of nonunion like open reduction of the fracture with freshening of fracture fragments, stabilization and bone grafting are very diYcult to the surgeon and the patient. Method: We herewith describe for the Wrst time in literature aprospective nonrandomized study of closing lateral wedge valgus intertrochanteric osteotomy in addition to dynamic hip screw osteosynthesis in the successful management of seven patients with varus trochanteric nonunion. Average operating time was 63 ± 13 min (range 39- 93 min) and blood loss was 212 ± 32 ml (range 156- 320 ml). Average pre-operative coxa vara of 9° ± 7° (range 85°-104°) had improved to a femoral neck shaft angle of 139° ± 4° (range 134°-145°) on postoperative radiographs. Results: All fractures and osteotomies had healed uneventfully at the last follow-up with good functional outcome. Harris Hip score had improved from 34 ± 6 (range 22-47) to 89 ± 4 (range 83-95) at an average of 11 months (range 7-13 months) follow-up. Valgus osteotomy converts shear forces across the fracture site into compressive forces thus achieving union.

Original languageEnglish
Pages (from-to)827-832
Number of pages6
JournalArchives of Orthopaedic and Trauma Surgery
Volume129
Issue number6
DOIs
Publication statusPublished - 2009

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Osteotomy
Biomechanical Phenomena
Hip
Coxa Vara
Fracture Healing
Bone Transplantation
Femur Neck
Therapeutics
Muscles

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

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title = "Closing lateral wedge valgus osteotomy with dynamic hip screw for the treatment of varus nonunion of pertrochanteric fracture: Can restoration of biomechanics and stabilization alone heal?",
abstract = "Introduction: Nonunion of pertrochanteric fracture is rare and its occurrence especially without prior surgical intervention has been hardly ever reported. Hence there is not much literature describing the best way to treat them. Nonunion of pertrochanteric fracture collapses in to varus by virtue of deforming action of muscles and thus deranging the biomechanics of the hip and indirectly preventing fracture union further. Hence it is very important to re-orient the abductor lever arm to biomechanically advantageous normal conWguration favoring fracture healing. In general, principles of treatment of nonunion like open reduction of the fracture with freshening of fracture fragments, stabilization and bone grafting are very diYcult to the surgeon and the patient. Method: We herewith describe for the Wrst time in literature aprospective nonrandomized study of closing lateral wedge valgus intertrochanteric osteotomy in addition to dynamic hip screw osteosynthesis in the successful management of seven patients with varus trochanteric nonunion. Average operating time was 63 ± 13 min (range 39- 93 min) and blood loss was 212 ± 32 ml (range 156- 320 ml). Average pre-operative coxa vara of 9° ± 7° (range 85°-104°) had improved to a femoral neck shaft angle of 139° ± 4° (range 134°-145°) on postoperative radiographs. Results: All fractures and osteotomies had healed uneventfully at the last follow-up with good functional outcome. Harris Hip score had improved from 34 ± 6 (range 22-47) to 89 ± 4 (range 83-95) at an average of 11 months (range 7-13 months) follow-up. Valgus osteotomy converts shear forces across the fracture site into compressive forces thus achieving union.",
author = "S. Vidyadhara and Rao, {Sharath K.} and S. Pandian and James Gnanadoss",
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T1 - Closing lateral wedge valgus osteotomy with dynamic hip screw for the treatment of varus nonunion of pertrochanteric fracture

T2 - Can restoration of biomechanics and stabilization alone heal?

AU - Vidyadhara, S.

AU - Rao, Sharath K.

AU - Pandian, S.

AU - Gnanadoss, James

PY - 2009

Y1 - 2009

N2 - Introduction: Nonunion of pertrochanteric fracture is rare and its occurrence especially without prior surgical intervention has been hardly ever reported. Hence there is not much literature describing the best way to treat them. Nonunion of pertrochanteric fracture collapses in to varus by virtue of deforming action of muscles and thus deranging the biomechanics of the hip and indirectly preventing fracture union further. Hence it is very important to re-orient the abductor lever arm to biomechanically advantageous normal conWguration favoring fracture healing. In general, principles of treatment of nonunion like open reduction of the fracture with freshening of fracture fragments, stabilization and bone grafting are very diYcult to the surgeon and the patient. Method: We herewith describe for the Wrst time in literature aprospective nonrandomized study of closing lateral wedge valgus intertrochanteric osteotomy in addition to dynamic hip screw osteosynthesis in the successful management of seven patients with varus trochanteric nonunion. Average operating time was 63 ± 13 min (range 39- 93 min) and blood loss was 212 ± 32 ml (range 156- 320 ml). Average pre-operative coxa vara of 9° ± 7° (range 85°-104°) had improved to a femoral neck shaft angle of 139° ± 4° (range 134°-145°) on postoperative radiographs. Results: All fractures and osteotomies had healed uneventfully at the last follow-up with good functional outcome. Harris Hip score had improved from 34 ± 6 (range 22-47) to 89 ± 4 (range 83-95) at an average of 11 months (range 7-13 months) follow-up. Valgus osteotomy converts shear forces across the fracture site into compressive forces thus achieving union.

AB - Introduction: Nonunion of pertrochanteric fracture is rare and its occurrence especially without prior surgical intervention has been hardly ever reported. Hence there is not much literature describing the best way to treat them. Nonunion of pertrochanteric fracture collapses in to varus by virtue of deforming action of muscles and thus deranging the biomechanics of the hip and indirectly preventing fracture union further. Hence it is very important to re-orient the abductor lever arm to biomechanically advantageous normal conWguration favoring fracture healing. In general, principles of treatment of nonunion like open reduction of the fracture with freshening of fracture fragments, stabilization and bone grafting are very diYcult to the surgeon and the patient. Method: We herewith describe for the Wrst time in literature aprospective nonrandomized study of closing lateral wedge valgus intertrochanteric osteotomy in addition to dynamic hip screw osteosynthesis in the successful management of seven patients with varus trochanteric nonunion. Average operating time was 63 ± 13 min (range 39- 93 min) and blood loss was 212 ± 32 ml (range 156- 320 ml). Average pre-operative coxa vara of 9° ± 7° (range 85°-104°) had improved to a femoral neck shaft angle of 139° ± 4° (range 134°-145°) on postoperative radiographs. Results: All fractures and osteotomies had healed uneventfully at the last follow-up with good functional outcome. Harris Hip score had improved from 34 ± 6 (range 22-47) to 89 ± 4 (range 83-95) at an average of 11 months (range 7-13 months) follow-up. Valgus osteotomy converts shear forces across the fracture site into compressive forces thus achieving union.

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SN - 0003-9330

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