Fracture neck of femur in young is rare and usually occur due to severe injuries like road traffic accident (RTA), fall from height etc. If the displaced fractures are not treated early, then it is often associated with complications. Non-union is one of the commonest complications. Treatment of non-union of these fractures in young is quite challenging.

1. Non-union fracture neck femur in a young patient

2. a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e2
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Interesting Rare Case Pictures
Non-union fracture neck femur in a young patient
Raju Vaishya a,*, Vipul Vijay b, K.C. Kapil Mani b, Vikas Birla b
a
b
Prof, Department of Orthopaedic Surgery, Indraprastha Apollo Hospitals, New Delhi, India
Department of Orthopaedic Surgery, Indraprastha Apollo Hospitals, New Delhi, India
1.
Case report
An 18-year-old boy fell 1 year ago from a tree and sustained
right hip injury, which was treated by traction. At presentation,
15 years ago, he had pain, deformity and 300 shortening and was
unable to bear weight on right leg. X-ray of the right hip showed
non-union with resorption of neck of femur and proximal
migration of femur (Fig. 1), but the head seemed viable.
A corrective valgus osteotomy with the fixation of fracture
was done using a Dynamic Hip Screw (DHS) with a 135 angle 4
hole plate. The patient did very well and both the osteotomy
and fracture united without any avascular necrosis of the
femoral head (Fig. 2). At 15 years follow up, the patient came
for a routine implant removal (Fig. 3), when he was totally
asymptomatic and has had only 1 cm of residual shortening of
right hip and almost full range of hip movements. The implants were removed without any significant event (Fig. 4).
Fracture neck of femur in young is rare and usually occur
due to severe injuries like road traffic accident (RTA), fall from
height etc. If the displaced fractures are not treated early then
it is often associated with complications. Non-union is one of
the commonest complications. Treatment of non-union of
these fractures in young is quite challenging. An attempt to
save the natural femoral head and hip joint is a priority and
hence corrective valgus osteotomy with fixation of the fracture with stable implant is a good choice and may achieve
union and preserve the natural hip joint, as it was in our case.
Joint replacement may be a secondary choice but considering
the young age of these patients, an attempt to fix the fracture
along with a corrective osteotomy must be considered first, as
it may preserve a natural hip joint.
Fig. 1 e Non-union of fracture neck femur with proximal
migration of the trochanter.
* Corresponding author.
E-mail address: raju.vaishya@gmail.com (R. Vaishya).
0976-0016/$ e see front matter Copyright ª 2014, Indraprastha Medical Corporation Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.apme.2014.01.005
Please cite this article in press as: Vaishya R, et al., Non-union fracture neck femur in a young patient, Apollo Medicine (2014),
http://dx.doi.org/10.1016/j.apme.2014.01.005

3. 2
a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e2
Fig. 4 e X-ray showing hip joint, with united fracture after
removal of implants.
2.
Fig. 2 e Early post op radiograph showing well fixed
osteotomy and uniting fracture.
Learning points
Fracture neck of femur in children are rare injuries and are
often caused by severe trauma
Early surgical treatment is essential for better outcomes
Neglected cases may need corrective osteotomy and
fixation
3.
Image quiz
What is diagnosis of this condition?
1.
2.
3.
4.
Dislocation of the hip
Fresh fracture neck of the femur
Non-union of fracture neck of femur
Dysplasia of the hip
Ans: Non-union of the fracture neck of femur with
resorption of neck and proximal migration of the trochanter.
Fig. 3 e 15 year follow up X-ray showing well united and
remodelled fracture with implants in situ.
Please cite this article in press as: Vaishya R, et al., Non-union fracture neck femur in a young patient, Apollo Medicine (2014),
http://dx.doi.org/10.1016/j.apme.2014.01.005

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