Non-union of femoral neck fractures may occur
due to mechanical and biological factors. Valgus intertrochanteric
osteotomy (VITO) alters hip biomechanics and
enhances fracture union. The double-angled 120° plate is
usually used for internal fixation of the osteotomy. It allows
the osteotomy to heal with medialisation and verticalisation
of the femoral shaft. This deformity causes medial ligament
strain of the knee joint, genu valgum and ultimately
osteoarthritis. This work presents our experience in treating
vertical fractures and non-unions of the femoral neck by
VITO and fixation by a single-angled 130º plate. Thirty-six
patients presented with 19 recent vertical femoral neck
fractures, and 17 non-unions were included. They were 26
men and ten women, and their ages averaged 37 years.
Preoperative planning and VITO technique are described.
Union was achieved in 35 patients (97%), and one recent
fracture failed to unite (3%). Time to fracture union averaged
four months in recent fractures and eight months in un-united
fractures. All patients with united fractures had an almost
normal configuration of the upper femur. Avascular necrosis
of the femoral head was reported in five patients. Twentytwo
patients (61%) were pain free, nine (25%) had hip pain
on lengthy walks and the remaining five (14%) had
persistent pain. Preoperative limb shortening averaged
2.5 cm, and post-operative shortening averaged 0.5 cm. We
recommend VITO and fixation by a single-angled 130º plate
for vertical femoral neck fractures and non-unions in
relatively young adult patients.