Valgus Osteotomy With Dynamic Hip Screw (DHS) Fixation for Nonunion and Malunion of Trochanteric Fractures: A Single-Center Experience

TL;DR

This study evaluates the effectiveness of valgus osteotomy with dynamic hip screw fixation for treating nonunion and malunion of hip fractures, finding generally good to excellent outcomes.

Contribution

The study provides new clinical evidence on the effectiveness of valgus osteotomy with DHS fixation for treating complex hip fracture cases.

Findings

The mean Harris Hip Score at three months was 84.74, indicating mostly good to excellent outcomes.

Outcomes were not significantly affected by gender, age, or mode of injury.

Falls were the most common cause of injury in the studied population.

Abstract

Objective

The objective of this study was to determine the functional of valgus osteotomy with dynamic hip screw (DHS) fixation in managing patients diagnosed with varus malunion and non-union trochanteric fractures.

Methodology

This descriptive case series was conducted at the Department of Orthopaedics and Spine Centre, Ghurki Trust Teaching Hospital, Lahore, Pakistan, from June 7, 2023, to December 7, 2023. A total of 80 patients aged above 40 years with malunited or non-united trochanteric fractures were included using non-probability consecutive sampling. Patients with active hip infections or lost to follow-up were excluded. Ethical approval was obtained, and informed consent was taken. All patients underwent valgus osteotomy under spinal anesthesia, followed by fixation with a DHS. Postoperative follow-ups were conducted at two and three months, with functional outcomes assessed using the Harris Hip Score (HHS) at three months. Data were analyzed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States), with p ≤ 0.05 considered statistically significant.

Results

The study included 80 patients with a mean age of 54.83 ± 10.41 years, predominantly male (85.0%). Falls were the most common mode of injury (n=48, 60.0%). The mean HHS at three months postoperatively was 84.74 ± 8.06, with 37.5% (n=30) of patients achieving excellent outcomes, 40.0% (n=32) good, 17.5% (n=14) fair, and 5% (n=4) poor. Stratification by gender, age, and mode of injury showed no statistically significant differences in outcomes (p > 0.05).

Conclusion

Valgus osteotomy with DHS fixation demonstrated good outcomes in the majority of participants, followed by excellent outcomes. While female and younger patients showed slightly better results, these differences were not statistically significant. Falls were the most common cause of injury, and the procedure achieved high success rates regardless of the mode of injury. These findings support valgus osteotomy with DHS fixation as a reliable treatment for nonunion and malunion trochanteric fractures.

Figures