Valgus sliding subtrochanteric osteotomy for neglected fractures of the proximal femur; surgical technique and a retrospective case series

BACKGROUND: Conventional technique of valgus osteotomy of the proximal femur involves removal of a partial or full thickness lateral based wedge from the peritrochanteric region. The purpose of this article is to describe a novel technique of valgus subtrochanteric osteotomy for proximal femur nonunion. METHODS: 11 patients with proximal femur nonunions {intracapsular fractures – 7, extracapsular fractures – 4} were treated using a new technique of sliding subtrochanteric osteotomy and DHS fixation. Outcomes analysed include radiological outcome in terms of improvement in Pauwel’s angle, neck-shaft angle and evidence of radiological union at the nonunion site and osteotomy site. Other outcomes analysed include, measurement of limb length discrepancy and functional outcome assessment with Oxford hip score. RESULTS: Union at the nonunion site and the osteotomy site was achieved in all patients. There were significant improvements in the postoperative Pauwel’s angle, neck shaft angle and Oxford hip score. Limb length discrepancy improved to less than 1 cm in all patients. There was no x ray evidence of avascular necrosis of the femoral head at one year follow-up. CONCLUSIONS: The sliding osteotomy technique is simple, does not need extensive pre operative planning or removal of bone from the proximal femur.