Outcomes for Pauwels’ Osteotomy in Nonunions of Displaced Femoral Neck Stress Fractures: A Case Series

Femoral neck stress fractures (FNSF) are rare injuries and have shown poor results after displacement, including nonunion and osteonecrosis (ON). The goal of this study was to retrospectively evaluate a series of patients who underwent a valgus producing intertrochanteric osteotomy for FNSF nonunion and assess the degree of Pauwels’ correction, ON rate, and return to duty. Current functional outcomes were prospectively obtained via a telephone script. Six patients underwent Pauwels’ osteotomy for FNSF nonunion, and all went onto bony union. Three of the six patients progressed onto ON, with two patients requiring a total hip arthroplasty due to life-limiting symptoms. Pauwels’ osteotomy is a reliable salvage procedure for FNSF nonunions. (Journal of Surgical Orthopaedic Advances 29(4):234–239, 2020)

Key words: femoral neck stress fractures, nonunions, Pauwel’s osteotomy, valgus intertrochanteric osteotomy