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Beitragstitel Persistent Femoral Neck Non-Union despite Intertrochanteric Valgisation Osteotomy : Relevance for secondary CAM type Impingement
Beitragscode P23
Autoren
  1. Veerle Franken HFR - Hôpital Cantonal Fribourg Vortragender
  2. Stefan Bluemel HFR - Hopital Cantonal Fribourgeois
  3. Vera Stetzelberger HFR - Hopital Cantonal Fribourgeois
  4. Matthieu Hanauer HFR - Hopital Cantonal Fribourgeois
  5. Moritz Tannast HFR Fribourg - University of Fribourg
Präsentationsform Poster
Themengebiete
  • A04 - Hüfte
Abstract Introduction
Valgisation osteotomy has successfully been used for many years as a treatment in delayed union of femoral neck fractures, through conversion of the fracture shear forces into compression forces (1,2). In case of persisting non-union of after valgisation osteotomy, femoral acetabular impingement should be excluded. Contact between fracture callus and the acetabular rim in flexion of the hip may result in micromotion of the fracture zone and limit or prevent consolidation.

Methods
We report a case of persisting non-union of a femoral neck fracture in a 25-year-old patient after a fall from 6m. Initial osteosynthesis was performed with 3 cannulated 7.3 mm screws (Fig. 1A and C). At 9 months follow up the patient presented with a symptomatic non-union with reduced ROM (E/F 0/0/90°, IR/ER 10/0/25°). A bone-scan showed evidence of preserved femoral head perfusion (Fig 2A). Therefore, an intertrochanteric valgisation osteotomy was performed using a 130° blade plate. (Fig. 1 B and D). A concomitant offset correction was not necessary since the femoral head-neck junction was spherical. At 11 months after valgisation, the patient presented with a healed intertrochanteric osteotomy, a persistent femoral neck non-union and secondary cam-type deformity due to excessive callus formation, persistent pain, and a limited ROM.

Results
Surgical hip dislocation with a trochanteric osteotomy and cam reduction was done 1 year after re-osteosynthesis. Femoral head necrosis was excluded by a drill hole, which showed bleeding. The cam deformity was clearly visible at the femoral neck (Fig. 2B). After cam reduction, mobilization under direct view showed an impingement free range of motion of the hip. A re-re-osteosynthesis of the femoral fracture was performed using a Synthes© Pediatric hip plate with an autologous bone graft to treat the pseudoarthrosis. Follow up at 2,5-year after final osteosynthesis and 1,5 years after hardware removal, showed a completely healed femoral neck fracture with minimal joint degeneration. Clinically the patient showed an improved ROM (E/F 0/0/90°, IR/ER 30/0/40°) with only intermittent hip pain most likely due to beginning joint degeneration.

Conclusion
In persistent non-union of femoral neck fractures after valgisation osteotomy, secondary CAM impingement caused by hypertrophic callus formation must be excluded. To obtain complete consolidation and good clinical results a CAM reduction by surgical hip luxation should be considered.