Systematic review of valgus intertrochanteric osteotomy in the setting of femoral neck fractures.

Introduction: Valgus intertrochanteric osteotomy (VITO) is a fixation procedure to manage neglected femoral neck fractures (FNF) in young adults. While several studies have evaluated the efficacy of VITO, there remains variability in intraoperative technique and fixation devices. The study aims to systematically review the current orthopedic literature to summarize the patient outcomes and determine the efficacy of VITO in young adults with neglected FNFs. Methods: All peer-reviewed studies written in English about VITO for neglected FNFs from 2000 to 2022 were searched using the National Center for Biotechnology Information (NCBI) PubMed MEDLINE database. Exclusion criteria included meta-analyses without primary data, single-patient case reports, and studies investigating pediatric populations. All included articles were analyzed for patient demographic data, Pauwels Classification, average time from injury to surgery and follow up, implant type, union versus nonunion, postoperative complications, need for corrective procedures, and surgical instrumentation utilized. Results: Eighteen articles that collectively provided data on 481 patients who underwent VITO were included. Most patients (66 %) included in this study had a Pauwels Type III. The most notable postoperative complication was osteonecrosis, which had an incidence of 8.3 %. Union was achieved in 92 % of cases at a mean follow-up of 48.6 months. Conclusion: VITO is a reliable and effective surgery to address nonunion of FNF in the young adult population. While the intraoperative device and correctional procedure used varied slightly, the majority of patients had an excellent postoperative Harris Hip Score (HHS) and achieved union by the last follow-up visit. Level of evidence: Level IV.