ABSTRACT
Femoral neck fractures in young patients have long been an enigma for treating surgeons. Nonunion rates as high as 43% have been reported in several series, which is considerably higher when compared to fractures in other regions of the skeletal system. This chapter describes different osteotomy techniques and the rationale for performing a valgus intertrochanteric osteotomy (VITO), the biomechanical advantages and limitations of VITO in treating a femoral neck nonunion. Compressive forces across the fracture tend to promote union, whereas shear forces impede union. Femoral neck nonunion is more commonly observed in vertical shear fracture patterns. During failure, the femoral head typically tends to drift and fail into varus, accentuating the degree of shearing, which ultimately leads to a nonunion. To understand the fundamentals of VITO, it is important to recognize the normal loading patterns of the hip joint and how they can affect or influence outcomes in femoral neck nonunion when treated with VITO.
