Treatment of non-united femoral neck fracture by a novel subtrochanteric angulation lateral translation valgus osteotomy (SALVA osteotomy).

Purpose: The ideal treatment of non-united and neglected fracture neck femur in the young adult still remains unclear and is characterized by many biological and biomechanical challenges.

Methods: Twenty-one patients with non-united or neglected fracture neck femur aged between 19 and 50 years were treated by a novel subtrochanteric valgus osteotomy and were followed up for a mean of 26.7 months. Patients were assessed by radiological parameters, the Harris Hip Score, Oxford Knee Score, and Askin Bryan Criteria to categorize the overall outcome of the patients at 24 months. Other outcome measures included the occurrence of AVN, adductor lever arm, leg length discrepancy, and mechanical implant failure.

Results: All patients treated with the SALVA osteotomy consolidated and displayed a marked improvement of functional and radiological outcome measures. Nevertheless, there were 2 mechanical failures in patients with marked osteopenia and three developed AVN.

Conclusions: In patients with un-united/neglected fracture neck femur, SALVA osteotomy appears to be reliable and reproducible. It also restores the abductor lever arm and improves the leg length discrepancy. Technically less demanding conversion to arthroplasty remains still possible prospectively.