Primary treatment of femoral neck fracture in young adults using valgus osteotomy and fixation by dynamic hip screw combined with cannulated screw

Background
For most femoral neck fractures in young adults, the recommended fixation technique is with multiple cancellous lag screws. The Pauwels types I and II fractures are the most amenable to this type of fixation. A Pauwels type III fracture is a vertically oriented fracture with more than 50° inclination angle from the horizontal line on an anteroposterior radiograph. This fracture is both axially and rotationally unstable and experiences increased shear forces leading to a higher rate of failure and nonunion. The treatment of this type of fracture remains controversial. Various treatment modalities have been proposed to improve the outcome of the treatment, such as treatment with valgus osteotomy and fixation with dynamic hip screw (DHS) and cannulated screws. The valgus osteotomy converts the shear force into compression increasing the stability of the implant.


Patient and methods
A total of 12 patients (10 males and two females) with acute Pauwels type III femoral neck fractures in the age group 22–48 years (mean, 28.5 years) were managed with valgus osteotomy and fixation with DHS and cannulated screws. The patients were followed up from 1 to 3 years (mean, 20 months).


Results
Clinically, the patients were evaluated according to the Harris Hip Score. Excellent results were achieved in eight patients, good in three, and fair in one. No evidence of infection occurred in any patient. Radiologically, the fracture united in all cases 6 months postoperatively. Avascular necrosis occurred in one case.


Conclusion
Vertical femoral neck fractures in young adults can be safely managed using valgus osteotomy and fixation with DHS augmented by cannulated screws.