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Osteosynthesis and primary valgus intertrochanteric osteotomy in displaced intracapsular fracture neck of femur with osteoporosis in adults
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Letters to the Editor
appropriately; the use of a simple knee splint to prevent knee flexion and therefore hip flexion may help in the immediate post-operative period in reducing hip dislocation rates.
Reference 1. Noon AP, Hockings M, Warner JG. Dislocated Thompson hemiarthroplasty–—the management of the recurrent dislocator. Injury 2005;36(5):618—21.
W.Y. Kim* Orthopaedics, North West Orthopaedic Rotation, 14 Croftleigh Close, Whitefield, Manchester M45 7DL, UK *Tel.: +44 7968866924 E-mail address: [email protected] doi:10.1016/j.injury.2005.12.029
LETTER TO THE EDITOR Osteosynthesis and primary valgus intertrochanteric osteotomy in displaced intracapsular fracture neck of femur with osteoporosis in adults We read with interest the article ‘‘Osteosynthesis and primary valgus intertrochanteric osteotomy in displaced intracapsular fracture neck of femur with osteoporosis in adults’’ by Magu et al. (Injury 2005;36:110—122). We compliment the authors for addressing this important issue with good biomechanical principles. Considering the high complication rate following intracapsular fracture neck of femur, as early as 1943, Blount proposed primary valgus osteotomy in recent fractures.3 In view of widespread osteoporosis in a younger population in the Indian subcontinent and an early age of hip fracture compared to the Western population,1,4 this procedure may have wider applications. Valgus osteotomy for primary fractured neck of femur has not gained widespread acceptability, possibly because of the apprehension of difficulty in conversion to total hip replacement for failed cases. Iwase et al.5 and several other operators did not encounter any major difficulty during conversion to total hip replacement following failed osteotomy. They emphasised the ease of intramedullary reaming during conversion to total hip replacement. DOI of original article: 10.1016/j.injury.2005.11.024.
We would like to inquire what was the resultant average femoral neck fracture angle achieved after the osteotomy. In cases of initial higher fracture inclinations, the post osteotomy neck shaft angle may exceed 1508 if the wedge resected is large. In such cases, the resultant higher neck shaft angle (>1508) is detrimental to hip function.2 Secondly, it would be interesting to know at what hip joint offset a lateralisation of the distal osteotomy fragment was undertaken? Although all the osteotomies ultimately united in this series, did a lateralisation procedure resulted in delayed union in any of their cases?
References 1. Ahuja M. Normal variation in density of selected human bones in North India. A necropsy study. J Bone Joint Surg 1969;51(2):B:719—35. 2. Barr RJ, Santore RF. Osteotomies about the hip-adults. In: Chapman MW, editor. Chapman’s orthopaedic surgery. 3rd ed., Philadelphia: Lippincott Williams and Wilkins; 2001. p. 2723— 68. 3. Blount WP, Wisconsin M. Blade plate internal fixation for high femoral osteotomies. J Bone Joint Surg 1943;25(2):319—39. 4. Gupta A. Osteoporosis in India–—the nutritional hypothesis. Natl Med J India 1996;9(6):268—74. 5. Iwase T, Hasegawa Y, Iwasada S, et al. Total hip arthroplasty after failed intertrochanteric valgus osteotomy for advanced osteoarthrosis. Clin Orthop Relat Res 1999;364:175—81.
Anil Agarwal* 131, Ankur Apartments, 7-I.P. Extension, Patparganj, Delhi 110092, India Aditya Agarwal Department of Orthopaedics, UCMS and GTB Hospital, Delhi 110095, India *Tel.: +91 11 22733244 E-mail Address: [email protected] doi:10.1016/j.injury.2005.11.023
AUTHOR’S REPLY Osteosynthesis and primary valgus intertrochanteric osteotomy in displaced intracapsular fracture neck of femur with osteoporosis in adults Sir, Thank you for the compliments and their queries. In our series the resultant average femoral neck—shaft DOI of original article: 10.1016/j.injury.2005.11.023.
Letters to the Editor
appropriately; the use of a simple knee splint to prevent knee flexion and therefore hip flexion may help in the immediate post-operative period in reducing hip dislocation rates.
Reference 1. Noon AP, Hockings M, Warner JG. Dislocated Thompson hemiarthroplasty–—the management of the recurrent dislocator. Injury 2005;36(5):618—21.
W.Y. Kim* Orthopaedics, North West Orthopaedic Rotation, 14 Croftleigh Close, Whitefield, Manchester M45 7DL, UK *Tel.: +44 7968866924 E-mail address: [email protected] doi:10.1016/j.injury.2005.12.029
LETTER TO THE EDITOR Osteosynthesis and primary valgus intertrochanteric osteotomy in displaced intracapsular fracture neck of femur with osteoporosis in adults We read with interest the article ‘‘Osteosynthesis and primary valgus intertrochanteric osteotomy in displaced intracapsular fracture neck of femur with osteoporosis in adults’’ by Magu et al. (Injury 2005;36:110—122). We compliment the authors for addressing this important issue with good biomechanical principles. Considering the high complication rate following intracapsular fracture neck of femur, as early as 1943, Blount proposed primary valgus osteotomy in recent fractures.3 In view of widespread osteoporosis in a younger population in the Indian subcontinent and an early age of hip fracture compared to the Western population,1,4 this procedure may have wider applications. Valgus osteotomy for primary fractured neck of femur has not gained widespread acceptability, possibly because of the apprehension of difficulty in conversion to total hip replacement for failed cases. Iwase et al.5 and several other operators did not encounter any major difficulty during conversion to total hip replacement following failed osteotomy. They emphasised the ease of intramedullary reaming during conversion to total hip replacement. DOI of original article: 10.1016/j.injury.2005.11.024.
We would like to inquire what was the resultant average femoral neck fracture angle achieved after the osteotomy. In cases of initial higher fracture inclinations, the post osteotomy neck shaft angle may exceed 1508 if the wedge resected is large. In such cases, the resultant higher neck shaft angle (>1508) is detrimental to hip function.2 Secondly, it would be interesting to know at what hip joint offset a lateralisation of the distal osteotomy fragment was undertaken? Although all the osteotomies ultimately united in this series, did a lateralisation procedure resulted in delayed union in any of their cases?
References 1. Ahuja M. Normal variation in density of selected human bones in North India. A necropsy study. J Bone Joint Surg 1969;51(2):B:719—35. 2. Barr RJ, Santore RF. Osteotomies about the hip-adults. In: Chapman MW, editor. Chapman’s orthopaedic surgery. 3rd ed., Philadelphia: Lippincott Williams and Wilkins; 2001. p. 2723— 68. 3. Blount WP, Wisconsin M. Blade plate internal fixation for high femoral osteotomies. J Bone Joint Surg 1943;25(2):319—39. 4. Gupta A. Osteoporosis in India–—the nutritional hypothesis. Natl Med J India 1996;9(6):268—74. 5. Iwase T, Hasegawa Y, Iwasada S, et al. Total hip arthroplasty after failed intertrochanteric valgus osteotomy for advanced osteoarthrosis. Clin Orthop Relat Res 1999;364:175—81.
Anil Agarwal* 131, Ankur Apartments, 7-I.P. Extension, Patparganj, Delhi 110092, India Aditya Agarwal Department of Orthopaedics, UCMS and GTB Hospital, Delhi 110095, India *Tel.: +91 11 22733244 E-mail Address: [email protected] doi:10.1016/j.injury.2005.11.023
AUTHOR’S REPLY Osteosynthesis and primary valgus intertrochanteric osteotomy in displaced intracapsular fracture neck of femur with osteoporosis in adults Sir, Thank you for the compliments and their queries. In our series the resultant average femoral neck—shaft DOI of original article: 10.1016/j.injury.2005.11.023.