Treatment of nonunion of femoral neck fracture by valgus osteotomy in 33 cases.

In spite of advances in treatment, femoral neck fractures are complicated fractures with a relatively high incidence of nonunion. Between 1990 and 2004, 33 patients with nonunion of femoral neck fractures were treated by valgus osteotomy in our department. The mean age of patients at the time of operation was 38 years (range 16-60 years). Reasons for nonunion were implant failure in 21 and osteomalacia in two patients. The remaining ten patients were treated nonoperatively. Average neck-shaft angle was 109° (78°-125°), and the average shortening of the involved limb was 2.5 cm (0.5-4.5). After subtrochanteric valgus osteotomy, fracture healing occurred in 32 of 33 patients. The average time for healing was five months (range 3-8 months). Pain and limitation of motion improved remarkably, and the majority of patients did not need to use crutches. Postoperatively, the neckshaft angle was 140° (125°-160°), and shortening reduced to an average of 1 cm. Partial avascular necrosis of the femoral head developed in five patients after 6-12 months. Valgus osteotomy of the femur is a suitable procedure for treatment of femoral neck nonunion in young patients, since it is easy to perform and yields relatively good results.