Free Vascularised Fibular Graft for Neglected Femoral Neck Fractures in Young Adults

Xie, Xuetao; Zhang, Changqing; Jin, Dongxu; Chen, Shengbao; Gao, You-Shui

doi:10.5301/hip.2012.9247

Cited by 12 publications

(12 citation statements)

References 25 publications

(41 reference statements)

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“…In this procedure closed or open reduction and CCS fixation of the fracture is performed after freshening the fracture surfaces. Some of the authors 12 13 14 15 16 17 18 used open reduction of fracture with freshening of fracture surfaces and placed cancellous autograft alongwith fibula. Fibula being cortical bone provides mechanical strength besides stimulating the union and getting incorporated as a biological graft.…”

Section: Discussionmentioning

confidence: 99%

“…5 were prospective 13 14 15 17 18 and 2 retrospective studies. 12 16 The total number of patients were 406.…”

Section: R Esultsmentioning

confidence: 99%

“…Various authors have described a wide array of options for treatment of neglected/NU femoral neck fracture. 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 There is lack of consensus in general, regarding the best option. This instructional course article is an analysis of available treatment options used for neglected femoral neck fracture in the literature and an attempt to suggest treatment guidelines for neglected femoral neck fracture.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of neglected femoral neck fracture

Jain

Mukunth

Srivastava

2015

IJOO

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Intra-capsular femoral neck fractures are seen commonly in elderly people following a low energy trauma. Femoral neck fracture has a devastating effect on the blood supply of the femoral head, which is directly proportional to the severity of trauma and displacement of the fracture. Various authors have described a wide array of options for treatment of neglected/nonunion (NU) femoral neck fracture. There is lack of consensus in general, regarding the best option. This Instructional course article is an analysis of available treatment options used for neglected femoral neck fracture in the literature and attempt to suggest treatment guides for neglected femoral neck fracture. We conducted the “Pubmed” search with the keywords “NU femoral neck fracture and/or neglected femoral neck fracture, muscle-pedicle bone graft in femoral neck fracture, fibular graft in femoral neck fracture and valgus osteotomy in femoral neck fracture.” A total of 203 print articles were obtained as the search result. Thirty three articles were included in the analysis and were categorized into four subgroups based on treatment options. (a) treated by muscle-pedicle bone grafting (MPBG), (b) closed/open reduction internal fixation and fibular grafting (c) open reduction and internal fixation with valgus osteotomy, (d) miscellaneous procedures. The data was pooled from all groups for mean neglect, the type of study (prospective or retrospective), classification used, procedure performed, mean followup available, outcome, complications, and reoperation if any. The outcome of neglected femoral neck fracture depends on the duration of neglect, as the changes occurring in the fracture area and fracture fragments decides the need and type of biological stimulus required for fracture union. In stage I and stage II (Sandhu's staging) neglected femoral neck fracture osteosynthesis with open reduction and bone grafting with MPBG or Valgus Osteotomy achieves fracture union in almost 90% cases. However, in stage III with or without AVN, the results of osteosynthesis are poor and the choice of treatment is replacement arthroplasty (hemi or total).

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Section: Discussionmentioning

confidence: 99%

“…5 were prospective 13 14 15 17 18 and 2 retrospective studies. 12 16 The total number of patients were 406.…”

Section: R Esultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment of neglected femoral neck fracture

Jain

Mukunth

Srivastava

2015

IJOO

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“…Avascular necrosis (AVN) of femoral head and nonunion is a major complication after the treatment of the displaced fracture of femoral neck in young adults [ 1 – 3 ]. The incidence of AVN is reported to be 6–42 %, and the incidence of nonunion is in the range of 0–45 % (average age of 38 years old, and the age range of 22–50 years old) [ 4 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

Biodegradable magnesium screws and vascularized iliac grafting for displaced femoral neck fracture in young adults

Zhao

Huang

et al. 2015

BMC Musculoskelet Disord

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ObjectiveAvascular necrosis of femoral head and nonunion is a major complication after the treatment of displaced femoral neck fracture in young adults.The purpose of this study was to introduce a new technique using biodegradable magnesium screws and vascularised iliac grafting for displaced femoral neck fracture in young adults.MethodsTotally 19 patients with displaced femoral neck fracture treated with this technique were retrospectively reviewed. The major steps of this technique included the harvesting of vascularized iliac graft, fixing of the fracture and biodegradable magnesium screws combined with vascularized iliac grafting implantation.ResultsAll patients were followed for an average of 16 months (range: 8–24 months). Clinical and radiological outcomes were evaluated. In 18 cases (94.7 %), the hip union was achieved at an average duration of 4.1 months (range: 3.6-5 months). The nonunion was observed in 1 hip (5.3 %) and the revision to a hip replacement was conducted after twelve months of the operation. According to the Harris hip score (HHS) that was available for 17 hips with satisfactory union, excellent results were achieved in 14 cases (HHS ≥ 90), fair results in 3 cases (HHS: 80–90), and poor result in 1 hip (HHS < 80). No patient developed avascular necrosis of femoral head after operation.ConclusionBiodegradable magnesium screws and vascularized iliac grafting based on the ascending branch of lateral femoral circumflex artery for displaced femoral neck fracture in young adults can provide the satisfactory results with a low rate of complications including avascular necrosis and nonunion.Trial registrationThis prospective and randomized controlled study was registered in the Chinese Clinical Trial Registry (ChiCTR-TRC-13003238). Date of registration: 2013-3-21.

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“…Despite the absence of a universal treatment protocol, there has been a marked improvement in the knowledge and management of ONFHN in the most recent decades due to the accumulation of further research on the multiple treatment methods. [1][2][3][4]6,[8][9][10][11][12][13][15][16][17][18][19][20][22][23][24][25][26][27][28][29][30][31][33][34][35][36][37][39][40][41][42][43]51 The treatment options for patients are categorized as surgical and nonsurgical interventions. The nonsurgical treatments include restricted weight bearing protocols and pain management, while the surgical options include core decompression (CD) and osteotomy, nonvascularized structural grafts, electrical stimulation, vascularized bone grafts, and THR or total hip arthroplasty (THA).…”

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confidence: 99%

The Effectiveness of Free Vascularized Fibular Flaps in Osteonecrosis of the Femoral Head and Neck: A Systematic Review

Ligh

Nelson

Fischer

et al. 2017

J reconstr Microsurg

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Free vascularized fibular flaps (FVFFs) are accepted surgical options to treat osteonecrosis of the femoral head and neck (ONFHN) to prevent conversion to total hip replacement (THR), yet many studies are single institution cohorts, with little generalizability. The purpose of this study was to perform a systematic review examining the comparative effectiveness of FVFF to treat ONFHN, particularly preventing conversion to a THR and improving hip function/symptoms. We searched PubMed and EMBASE databases using femoral head, free fibula, and femoral neck keywords. Articles were excluded if not translated into English, < 10 hips, article was a compilation/review, outcomes were not relevant, or prior to 1994. If from the same institution, we included the largest cohort and excluded others within the same timeline. Two investigators independently reviewed articles and reported number of patients/hips, average age/follow-up time/graft survival before THR, Harris hip score, THR rate, complications, and radiographic progression rates. We identified 128 and 157 articles from PubMed and EMBASE. After screening/duplicate removal, 21 studies were included from 14 institutions in 9 countries. Overall, 71% were level IV evidence. The average patient number was 129, number of hips was 166, age at surgery was 34 years, and follow-up time was 92 months. HHS improved on average 21.7 points, with the number of patients requiring THR being 19.4%. Graft survival before THR was 5.2 years, and 47.7% of hips had radiographic progression. There is a significant amount of level IV evidence describing the favorable role of FVFF to treat ONFHN. Although efficacious, there is a need for higher level evidence. The level of evidence is 3.

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Free Vascularised Fibular Graft for Neglected Femoral Neck Fractures in Young Adults

Cited by 12 publications

References 25 publications

Treatment of neglected femoral neck fracture

Treatment of neglected femoral neck fracture

Biodegradable magnesium screws and vascularized iliac grafting for displaced femoral neck fracture in young adults

The Effectiveness of Free Vascularized Fibular Flaps in Osteonecrosis of the Femoral Head and Neck: A Systematic Review

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