Abstract
BACKGROUND: Nonunion of femoral neck fractures following internal fixation presents a significant challenge, particularly in young patients. This study evaluated the efficacy of valgus osteotomy in treating femoral neck fracture nonunion after failed internal fixation in young adults. METHODS: A retrospective analysis was conducted including a total of 23 male patients with a mean age of 32.9 years, who underwent valgus osteotomy for femoral neck fracture nonunion. The procedure involved lateral closing wedge osteotomy at the subtrochanteric level, followed by fixation with a dynamic hip screw (DHS). The postoperative follow-up period exceeded one year. RESULTS: Significant improvements in biomechanical parameters were observed. The mean neck-shaft angle increased from 118.91° to 139.26° (p < 0.001), whereas the Pauwels angle decreased from 62.07° to 46.91° (p < 0.001). The median Harris Hip Score improved from 63 to 96 (p < 0.001). Limb length demonstrated a trend toward improvement, increasing from a median of 73.30-74.50 cm, although this was not statistically significant (p = 0.077). Union was achieved in 22 of 23 patients, with a median healing time of 8.5 months. CONCLUSION: Valgus osteotomy is an effective treatment for femoral neck fracture nonunion in young adults, offering improved biomechanics, good union rates, and enhanced functional outcomes. This technique is a viable option for preserving the native hip joint in challenging patients.