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Impaction Bone Grafting and Valgus Osteotomy

A Technical Trick for the Treatment of Femoral Neck Nonunions

Jayaramaraju, Dheenadhayalan MS*; Valleri, Durga Prasad DNB*; Agraharam, Devendra DNB*; Shanmuganathan, Rajasekaran PhD

doi: 10.1097/BOT.0000000000001564
Technical Trick

Summary: Femoral neck nonunions in young adults is among the most challenging problems to treat. This is due to their inherent problems, such as neck resorption, increase in fracture gap, sclerosis of fracture margins, and avascular necrosis. Hip salvage in these cases, although challenging, is recommended in the Asian subcontinent where social and religious activities require squatting and sitting cross-legged. Muscle pedicle grafts and other vascularized bone grafting techniques are preferred treatment options, but they are technically demanding and require advanced microsurgical skills. Valgus osteotomy, although successful in certain cases, has a high failure rate in patients with poor bone stock. We present a simple technique of valgus subtrochanteric osteotomy, impaction bone grafting, and stabilization with a sliding hip screw. Here, we describe in detail about the surgical technique and present the clinical outcomes in 44 patients, with a mean follow-up of 3.4 years and a union rate of 95.5%.

*Division of Orthopaedics and Trauma, Ganga Hospital, Coimbatore, India; and

Division of Orthopaedics, Trauma and Spine Surgery, Ganga Hospital, Coimbatore, India.

Reprints: Dheenadhayalan Jayaramaraju, MS, Department Orthopaedics and Traumatology, Ganga Hospital, 313, Mettupalayam Rd, Coimbatore 641043, India (e-mail:

The authors report no conflict of interest.

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Accepted May 22, 2019

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