Femoral neck nonunion in young patients has always been a difficult problem to deal with for surgeons. Numerous surgical procedures to address either the biological or mechanical issues at the nonunion have been described and most of them have been associated with variable results. Isolated biological augmentation is often associated with poor results and some techniques like vascularized grafting may require not so commonly available expertise. Valgus osteotomy is aimed to correct the abnormal fracture biomechanics associated with femoral neck fractures. By altering the nature of force transmission across the nonunion, shear forces are converted into compressive forces that lead to rapid osseous union without the need for bone grafting. Though the principles are sound and were described a long time ago, the technical aspects have evolved over time. Various modifications have been described to overcome shortcomings such as limb length discrepancy, reduction of femoral offset, alteration in mechanical axis, and the overall proximal femur anatomy. In this review, we look back at the fundamental principles and recent literature on the results of valgus intertrochanteric osteotomy for femoral neck pseudoarthrosis. We also highlight the important need for accurate preoperative planning and surgical execution. Lastly, we elaborate on the technical improvisations that have happened over time in order to improve functional results and to minimize complications and poor outcome after a valgus osteotomy.

Introduction: Thoracolumbar fractures are the most common injuries being treated by spine surgeons. Conventionally these fracture were treated with 2 levels above and 2 levels below the fracture site. The goal of internal fixation is to minimize the number of vertebral levels involved in fusion of a spine fracture. This is achievable by utilizing short same segment posterior fixation (SSPF). SSPF is the use of pedicle screw instrumentation one level cephalad to and one level caudal to the fracture vertebra and pedicle screw inserted into the fractured vertebra. Materials & Methods: 15 patients who were operated between Jan 2012 to January 2015 were taken for the retrospective analysis. All patients were surgically treated with short same segment fixation using a posterior surgical approach with transpedicular instrumentation. Pedicle screws were placed at one level above and below the fracture site. Additionally, pedicle screws were also inserted at the level of the fracture. Connected with rods. Results and analysis: All the patients were followed up at 3 months, 6 months and 12 months postoperatively. The Mean pre-operative kyphosis was 14° (range 6° to 24°). Average post-operative kyphosis was 0° (range 6° to −18°). Average follow-up kyphosis of all cases was 10° (range 0.85° to 35.00°). Excluding failures, average follow-up kyphosis was 8° (range 0.85° to 25.00°). The height of the vertebral body was maintained upto 95% in 6 patients, 80% in 6 patients, and 70% in 3 patients. At initial one-month follow-up, average Oswestry disability score was severe at 52.63% (range 16% to 84%). At most recent follow-up, average Oswestry disability score was minimal at 5.5% (range 0% to 16%). One patient was lost to long-term follow-up. Mean difference from one-month follow-up to most recent follow-up (excluding failures) was 47.27% (P < 0.0001). Conclusion: In our study the short same-segment fixation decreases implantation failure rate and reoperation rate. However long term kyphosis correction was not maintained. Despite this loss of kyphosis correction, clinical pain and disability improved at long-term follow-up.