Non-wedge Technique for Valgus Subtrochanteric Osteotomy in Pediatric Femoral Neck Non-union

Abstract

Aims: The aim of this retrospective study was to evaluate the clinical and radiological outcomes of using valgus subtrochanteric osteotomy in pediatric femoral neck non-union in terms of Ratliff functional score and time to union respectively. Study Design: Case Series. Place and Duration of Study: Ghurki Trust Teaching Hospital Lahore Pakistan. Study conducted between Jan 2016 to Dec 2019. Methodology: This was a retrospective study of 5 children with femoral neck non-union who underwent osteosynthesis and valgus subtrochanteric osteotomy at Ghurki Trust Teaching hospital between 2016 and 2019. Clinico-demographic profile of patients and functional and radiological outcomes in terms of Ratliff grading and time to union respectively are reported. All patients had a minimum of 2 years followup. Results: This study included five patients (two males and three females with mean age of 9.8 ± 1.92 years). All patients achieved fracture union, seen within an average of 18 ±6.37 weeks and of the osteotomy site within 13 ± 2.9 weeks. Neck shaft angle improved from average 107 degrees (range 100-110) preoperatively to 137 degrees postoperatively (range 130-140). Pre-operative radiologic signs of AVN was shown in all patients which disappeared completely in 4 patients. Mean limb-length discrepancy decreased from 2.9 cm preoperatively to 0.8 ± 0.57cm post-operatively. According to Ratliff criteria, 4patients had good whereas one patient had fair functional outcome. There were no intra-operative or early post-operative complications recorded in our series. Conclusion: We report that valgus subtrochanteric osteotomy in non-united femoral neck fractures in children is cost-ef­fective and technically less demanding procedure and is associated with good clinical and radiological outcomes.