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Valgus intertrochanteric osteotomy in the management of posttraumatic non-unions and deformities of the proximal femur
Authors: J. Bartoníček; A. Chochola; M. Tuček; J. Alt
Authors‘ workplace: Klinika ortopedie 1. LF UK a ÚVN – VFN Praha
Published in: Rozhl. Chir., 2026, roč. 105, č. 1, s. 5-12.
Category: Review
doi: https://doi.org/10.48095/ccrvch2026Overview
Fractures of the proximal femur, i.e., femoral neck fractures and trochanteric fractures, may be associated with a number of late complications. The most frequent of them include non-union, varus malunion, unequal limb length, avascular necrosis of the femoral head, malrotation of the extremity and osteoarthritis of the hip joint.
Individual affections are very often combined, for example, varus malunion, shortening of the limb and its malrotation. This may result in pain, limp and, later, in disorders of other joints, especially the knee, and the lumbar spine. In the past, many of these complications were treated with intertrochanteric osteotomy. Currently, however, the indications for osteotomies have significantly decreased due to advances in internal fixation of proximal femur fractures and the introduction of THA. Nevertheless, intertrochanteric osteotomy remains the method of choice in management of certain complications of proximal femur fractures. Not every orthopedist or traumatologist has the capacity to perform these surgeries, but everyone should know about them and their indications.
The aim of this article is therefore to give a brief overview of the current possibilities of valgus intertrochanteric osteotomy in the management of posttraumatic non-unions of the femoral neck.
Keywords:
proximal femur fractures – valgus intertrochanteric osteotomy – femoral neck non-union – varus trochanteric malunion
Sources
- Bartoníček J. Complications of trochanteric fractures. In: Waddell JP (ed). The proximal femur fractures. Improving outcomes. Philadelphia: Saunders-Elsevier 2011 : 151–181.
- Müller ME. Die hüftnähen Femurosteotomien. Stuttgart: Thieme 1971.
- Pauwels F. Der Schenkelhalsbruch. Ein mechanisches Problem. Stuttgart: Enke 1935.
- Pauwels F. Biomechanics of the normal and diseased hip. Berlin: Springer 1976.
- Schatzker J. The intertrochanteric osteotomy. Berlin: Springer 1984.
- Weber BG, Čech O. Pseudoarthrosis. Bern: Huber 1976.
- Ballmer FT, Ballmer PM, Mast JW et al. Results of repositioning osteotomies in delayed healing or pseudarthrosis of the proximal femur. Unfallchirurg 1992; 95(10): 511–517.
- Marti RK, Raaymakers EL, Nolte P et al. Pseudarthrosis of the proximal femur. Orthopade 1996; 25(5): 454–462. doi: 10.1007/ s001320050047.
- Raaymakers EL. Fractures of the femoral neck: a review and personal statement. Acta Chir Orthop Traumatol Cech 2006; 73(1): 45–59.
- Bartoníček J, Vávra J. Význam MR v léčbě komplikací zlomenin krčku femuru u adolescentů. Ortopedie 2012; 6(1): 25–29.
- Bartoníček J, Chochola A. Intertrochanterické osteotomie v éře aloplastiky. Ortopedie 2013; 7(5): 189–192.
- Marti RK, Schüller HM, Raaymakers EL. Intertrochanteric osteotomy for non-union of the femoral neck. J Bone Joint Surg 1989; 71(5): 782–787. doi: 10.1302/0301-620X.71B5.2584247.
- Kalra M, Anand S. Valgus intertrochanteric osteotomy for neglected femoral neck fractures in young adults. Int Orthop 2001; 25(6): 363–366. doi: 10.1007/s002640100288.
- Hartford JM, Patel A, Powell J. Intertrochanteric osteotomy using a dynamic hip screw for femoral neck nonunion. J Orthop Trauma 2005; 19(5): 329–333.
- Sringari T, Jain UK, Sharma VD. Role of valgus osteotomy and fixation by double-angle blade plate in neglected displaced intracapsular fracture of neck of femur in younger patients. Injury 2005; 36(5): 630–634. doi: 10.1016/ j.injury.2004.10.020.
- Schoenfeld AJ, Vrabec GA. Valgus osteotomy of the proximal femur with sliding hip screw for the treatment of femoral neck nonunions: the technique, a case series, and literature review. J Orthop Trauma 2006; 20(7): 485–491. doi: 10.1097/ 00005131-200608000-00006.
- Min BW, Bae KC, Kang CH et al. Valgus intertrochanteric osteotomy for non-union of femoral neck fracture. Injury 2006; 37(8): 786–790. doi: 10.1016/j.injury.2006.02.045.
- Said GZ, Farouk O, Said HG. Valgus intertrochanteric osteotomy with single-angled 130° plate fixation for fractures and non-unions of the femoral neck. Int Orthop 2010; 34(8): 1291–1295. doi: 10.1007/s00264-009-0885-z.
- Sen RK, Tripathy SK, Goyal T et al. Osteosynthesis of femoral-neck nonunion with angle blade plate and autogenous fibular graft. Int Orthop 2012; 36(4): 827–832. doi: 10.1007/s00264-011-1344-1.
- Varghese VD, Boopalan PR, Titus VT et al. Indices affecting outcome of neglected femoral neck fractures after valgus intertrochanteric osteotomy. J Orthop Trauma 2014; 28(7): 410–416. doi: 10.1097/BOT.0000000000000030.
- Magu NK, Singla R, Rohilla R et al. Modified Pauwels‘ intertrochanteric osteotomy in the management of nonunion of a femoral neck fracture following failed osteosynthesis. Bone Joint J 2014; 96-B(9): 1198–1201. doi: 10.1302/0301-620X.96B9.33530.
- Yuan BJ, Shearer DW, Barei DP et al. Intertrochanteric osteotomy for femoral neck nonunion: Does “undercorrection” result in an acceptable rate of femoral neck union? J Orthop Trauma 2017; 31(8): 420–426. doi: 10.1097/BOT.0000000000000869.
- Bartoníček J. Pauwels‘ classification of femoral neck fractures: correct interpretation of the original. J Orthop Trauma 2001; 15(5): 358–360. doi: 10.1097/00005131-200106000-00009.
- Bartoníček J, Skála-Rosenbaum J, Douša P. Valgus intertrochanteric osteotomy for malunion and nonunion of trochanteric fractures. J Orthop Trauma 2003; 17(9): 606–612. doi: 10.1097/00005131-200310000-00002.
- Vidyadhara S, Rao SK, Pandian S et al. Closing lateral wedge valgus osteotomy with dynamic hip screw for the treatment of varus nonunion of pertrochanteric fracture: can restoration of biomechanics and stabilization alone heal? Arch Orthop Trauma Surg 2009; 129(6): 827–832. doi: 10.1007/s00402-008-0791-7.
- El-Alfy B, Abououf A, Darweash A et al. The effect of valgus reduction on resistant subtrochanteric femoral non-unions: a single-centre report of twenty six cases. Int Orthop 2024; 48(4): 1105–1111. doi: 10.1007/s00264-023-06085-1.
- Anglen JO. Intertrochanteric ostetomy for failed internal fixation of femoral neck fracture. Clin Orthop Rel Res 1997; 341 : 175–182.
- Mayo K, Kuldjanov D. Generic preoperative planning for proximal femoral osteotomy in the treatment of nonunion of the femoral neck. J Orthop Trauma 2018; 32(Suppl 1): S46–S54. doi: 10.1097/BOT.0000000000001087.
- Mathews V, Cabanela ME. Femoral neck nonunion treatment. Clin Orthop Relat Res 2004; 419 : 57–64. doi: 10.1097/00003086-200402000-00010.
- Gavaskar AS, Srinivasan P, Jeyakumar B et al. Valgus intertrochanteric osteotomy for femur neck pseudoarthrosis: a simple solution to a complex problem that has stood the test of time. Int Orthop 2020; 44(4): 635–643. doi: 10.1007/s00264-019-04353-7.
- Hollyer I, Johnson TR, Wadwa H et al. Preliminary study on the stabilization of varus proximal femoral osteotomies using pediatric LCP plates in adults undergoing combined correction of proximal femoral and acetabular dysplasia. Eur J Orthop Surg Traumatol 2024; 34(1): 231–236. doi: 10.1007/s00590-023-03640-9.
- Wagner H, Wagner M. Reconstructive hip surgery – valgus intertrochanteric osteotomy. In: Bauer R, Kerschbaumer F, Poisel S (eds). Atlas of hip surgery. Stuttgart: Thieme 1996.
- Bartoníček J, Vávra J. Valgus intertrochanteric osteotomy for coxa vara of Bucholz-Ogden Types II and III in patients older than 30 years. Arch Orthop Trauma Surg 2011; 131(9): 1211–1217. doi: 10.1007/s00402-011-1278-5.
- Chochola A, Bartoníček J, Douša P et al. Long-term results of valgus intertrochanteric osteotomy for partial avascular necrosis of the femoral head after femoral neck fracture in adolescents. BMC Musculoskelet Disord 2023; 24(1): 460. doi: 10.1186/s12891-023-06598-1.
MUDr. Jan Alt
Klinika ortopedie
1. LF UK a ÚVN – VFN Praha
U Vojenské nemocnice 1200/1
169 02 Praha 6
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Surgery Orthopaedics Trauma surgery
Article was published inPerspectives in Surgery
2026 Issue 1-
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