A study of the role of McMurray osteotomy in the management of neglected, ununited femoral neck fractures in young adults in present day orthopaedics

Abstract

Aim: To evaluate the role of the McMurray Osteotomy in present day orthopaedics in the management of neglected and ununited femoral neck fractures in young adults by assessment of clinical, radiographic and functional results in them. Material & Methods: Young adults within the age group of 15–45 years with ununited, neglected fractures of femoral neck were included in the study. All patients underwent McMurray Osteotomy followed by hip spica immobilization. The osteotomies were not surgically fixed. The post-operative complications and functional recovery was assessed using Charnley’s modification of Merle D’Aubigne and Postel hip scoring. Results: A total of 12 patients were included in the study. The average time of union following the procedure was found to be approximately 8.83 months (SD +/-1.23). There were seven cases of delayed union and no cases of avascular necrosis. Eight patients (66.67 %) had good post-operative functional results and 3 patients (25%) had satisfactory results. Conclusion: The incidence of ununited femoral neck fractures in young adults, especially those complicated by neglect, is significant. One should develop criteria for opting for head salvage to avoid arbitrarily managing these cases with replacement arthroplasty. Though the McMurray Osteotomy is known to distort proximal femoral anatomy, which may complicate later THR, the ‘arm chair effect’ conferred by this procedure, makes it suitable in young patients with viable heads and significantly resorbed necks, for painless weightbearing, where chances of union may be improbable if not impossible. Supplemental internal fixation of osteotomy may help early mobilization and get better functional results.