Functional Outcomes of Valgus Osteotomy in Young Patients of Intracapsular Neck of Femur Fracture: A Case Series.

INTRODUCTION: Intracapsular fractures of the femoral neck continue to represent one of the most demanding injuries encountered by orthopedic surgeons, particularly in young adults. Preservation of the femoral head remains the primary objective because arthroplasty in this age group is associated with limited implant longevity and the likelihood of multiple revision procedures. Valgus intertrochanteric osteotomy, originally described by Pauwels, alters fracture biomechanics by transforming vertical shear forces into compressive forces, thereby enhancing fracture stability and promoting union. This study evaluates the clinical and radiological outcomes of valgus intertrochanteric osteotomy in young patients presenting with Pauwels Type II and III intracapsular neck of femur fractures. MATERIALS AND METHODS: A retrospective case series comprising twenty-five patients younger than 60 years with Pauwels Type II or III intracapsular neck of femur fractures was conducted at a tertiary care center. Fresh fractures presenting within 24 h as well as delayed presentations up to 3 months were included. Patients underwent valgus intertrochanteric osteotomy using fixed-angle internal fixation according to fracture configuration and surgeon preference. Clinical records and serial radiographs were reviewed to evaluate fracture union, delayed union, fixation failure, and complications. The study was approved by the Institutional Ethics Committee, and valid written informed consent was obtained from all participants after explaining the procedure and study objectives. RESULTS: Among the 25 patients included in the series, fracture union was achieved in 15 patients, delayed union occurred in 4 patients, and 6 patients demonstrated fixation failure requiring further management. The overall healing rate was 76%. The procedure successfully restored mechanical alignment and preserved the native femoral head in the majority of patients. CONCLUSION: Valgus intertrochanteric osteotomy continues to be an effective biological solution for selected intracapsular femoral neck fractures in young adults. Appropriate patient selection, meticulous pre-operative planning, and stable fixation remain critical determinants of successful outcomes. In appropriately selected patients, this procedure provides an economical and reproducible alternative to arthroplasty while preserving future reconstructive options.