Fixation with Cancellous Screws and Fibular Strut Grafts for Neglected Femoral Neck Fractures

Abstract

Purpose. To review the outcomes of fixation with cancellous screws and fibular strut grafts for neglected femoral neck fractures. Methods. 44 men and 28 women aged 17 to 50 years with neglected femoral neck fractures of the subcapital (n=12), transcervical (n=57), or basal (n=3) types underwent closed (n=39) or open (n=33) reduction and fixation with a single cancellous screw with double fibular strut grafts (n=24) or fixation with double cancellous screws with a single fibular strut graft (n=48). The mean time from injury to surgery was 10 weeks; the delay was 22 to 35 days in 43 patients and >35 days in 29 patients. Double fibular strut grafts were used for 18 patients with longer delay and resorption of the femoral neck, and 18 patients with posterior comminution of the femoral neck. The outcome was assessed using the Harris hip score. Results. Patients were followed up for a mean of 3 years. The time to bone union was 3 to 4 months in Fixation with cancellous screws and fibular strut grafts for neglected femoral neck fractures

Nonvascularized fbular grafting in nonunion of femoral neck fracture

“…The definition of neglected femoral neck fracture varies in these articles. Nine articles reported more than 3 weeks of delay as neglected, 17 23 24 26 27 28 29 30 32 whereas remaining articles mentioned more than 6 weeks as the definition of neglected fracture. 19 25 31 However, the definition of nonunion is quite clear.…”

“… 22 23 28 29 30 31 32 Five articles reported CR where possible and OR when CR failed. 20 21 24 25 26 The authors supporting OR assert that by opening the nonunion site, the interposed fibrous tissue between the fracture fragments can be removed. Moreover, the fracture ends can be freshened, and the neck-shaft angle can be adjusted.…”

Surgical treatment of neglected hip fracture in children with cerebral palsy: case report and review of the literature

“…However, their use was associated with some complications such as donor site pain, graft fracture, and gait pattern modification (15,23,(29)(30)(31). We preferred to avoid the use of fibular strut graft considering the risk of gait impairment as reported in literature (31).…”

“…We preferred to avoid the use of fibular strut graft considering the risk of gait impairment as reported in literature (31). Several Authors showed good outcomes using cannulated screws associated with both fibular strut graft (29,30,32) and cancellous bone graft (33). Recently, a biomechanical study demonstrated that placing a third cannulated cancellous screw in the calcar provide a stability advantage for femoral neck fractures fixation (34).…”

Long Term Results of Fresh Femoral Neck Fractures Treated by Cancellous Screw and Fibular Autograft

“…C) vascularized fibular graft have been advocated along with or without internal fixation along with valgus osteotomy to treat neglected fractures and ununited femoral neck fractures to promote union. [5][6][7][8][9][10][11][12][13][14][15][16][17] Bone graft supplementation by using free fibular grafting was in past used in fifth decade but with less satisfying results. [18][19][20] In India it was revived in 1981 and first results were published in 1986.…”