Valgus intertrochanteric osteotomy for malunion and nonunion of trochanteric fractures.

Abstract

To evaluate the results of valgus intertrochanteric osteotomy for varus nonunion and malunion of trochanteric fractures. University hospital. Retrospective clinical study. Fifteen patients (age range 29-84 years) with varus malunion (11 cases) or varus nonunion (4 cases). Indication for surgery was nonunion or varus malunion with limb shortening greater than 2 cm associated with limp, abductor muscle insufficiency, hip pain, and back pain. The patients were treated by a valgus intertrochanteric osteotomy fixed with a 120 degrees double-angled blade plate. Average follow-up was 5.5 years (range 2-10 years). Fourteen patients healed without complications: 12 patients within 4 months; 2 delayed unions within 6 months. One patient required revision surgery for a loss of fixation due to a fall 6 weeks after surgery. This osteotomy also healed. Average lengthening achieved by osteotomy was 2 cm (range 1-5 cm). In all patients, the resulting range of flexion in the hip joint was greater than 90 degrees, Harris hip score before surgery was 73 points (range 61-83), and after surgery 92 points (range 76-98). Osteoarthritis or avascular necrosis of the femoral head did not develop in any of the cases. Valgus intertrochanteric osteotomy is an effective procedure that reliably restores hip function in trochanteric malunion or nonunion.