Valgus Osteotomy versus Hemiarthroplasty for Neglected Type 2 Fracture Neck Femur in Middle-aged Group

Background: Neglected fractures of the femoral neck in middle-aged present unique challenge as there is no fixed method of management, and hence, decision regarding the choice of procedure is always a task. Being neglected, there is an increased risk of complications such as nonunion, avascular necrosis, and joint dysfunction. These fractures are often the result of high-energy trauma, particularly in developing countries where access to timely medical intervention may be limited. Objective: The objective of this study was to compare valgus osteotomy and hemiarthroplasty for neglected type 2 femoral neck fractures in middle-aged group. Materials and Methods: A prospective study was conducted involving 30 patients with neglected femoral neck fractures. Patients were divided into two groups based on the treatment received: hemiarthroplasty or valgus osteotomy with dynamic hip screw (DHS; hip salvage surgery). The study evaluated outcomes based on the Harris Hip Score (HHS), complication rates, full weight-bearing time, and incidence of complications such as infection, hip dislocation, and avascular necrosis. Results: The study found that hemiarthroplasty led to faster recovery, with patients achieving full weight-bearing significantly earlier (mean 15.52 ± 2.952 days) compared to valgus osteotomy with DHS (mean 124.91 ± 12.204 days). However, both treatments achieved comparable long-term functional outcomes as measured by the HHS. Valgus osteotomy showed a higher incidence of infection compared to hip replacement. Conclusion: While hemiarthroplasty offers quicker recovery and early mobility, valgus osteotomy with DHS remains a valuable joint-preserving option, especially in more active patients, particularly in Indian setting where squatting and sitting cross legged in very common. The choice of treatment should be based on patient activity level and demands, and associated risks of complications.