Modified valgus osteotomy of the femoral neck for late presenting femoral neck stress fractures in military recruits
A 26-year-old military man presented to us with a complaint of pain in the right hip and a limp for a duration of eight weeks. There was no history of trauma. He consulted a local clinic after one month of his field training when he had vague pain in the right hip. A radiograph was prescribed, which showed no abnormality. He was advised anti-inflammatory drugs. Despite relief in symptoms for a short period, with mechanical activity his pain and limp aggravated.\nClinical examination revealed tenderness in the right Scarpa's triangle, hip flexion of 110°, abduction of 30°, adduction of 10° and external rotation of 15° and no internal rotation. There was a shortening of 1.5 cm. Plain radiographs of the pelvis with both hips showed a partially displaced femoral neck fracture with a varus deformity []. The fracture surfaces were smooth. Magnetic resonance imaging confirmed the viability of the femoral head []. He was offered surgical treatment and he underwent realignment osteotomy at the basicervical area. After reduction fixation was done with three partially threaded cancellous screws. Active and passive physiotherapy was started as tolerated by the patient in the immediate postoperative period. Crutch walking with non-weight bearing on the affected limb was instructed for a period of six weeks. Subsequently gradual weight bearing was allowed, with full weight bearing achieved after two months. At the end of the four-year followup, there was no evidence of avascular necrosis of the head of the femur [] and the Harris hip score was 92, indicating excellent functionality [].