Internal fixation of ununited femoral neck fractures combined with muscle-pedicle bone grafting

Abstract

Fifty-six patients with ununited intracapsular fractures of the femoral neck were treated by internal fixation and muscle-pedicle bone grafting. All had some absorption of the femoral neck, and many had avascular necrosis of the femoral head. At operation the sclerosed surfaces of the fractures were freshened, the avascular femoral head was decompressed and the muscle-pedicle graft was fixed with silk thread wrapped around pins. Satisfactory union occurred in 42 patients (75%), and delayed union in seven, of whom four (7%) eventually united without further treatment and three united after osteotomy. Non-union occurred in five patients and technical failure in two.

The Neglected Femoral Neck Fracture in Young Adults: Review of a Challenging Problem

“…Meyers et al 6 and Baksi 32 have employed vascularized grafts using muscle pedicle grafts in separate studies involving patients with a delay of more than 3 months. Unfortunately, the blood supply with this construct is unreliable, and there was a high incidence of non-union.…”

Modified Pauwels’ Intertrochanteric Osteotomy in Neglected Femoral Neck Fracture

“…Similarly, shortening of 0.9 to 3.9 cm (mean, 2.9 cm) was reported by Nagi et al [25]. Coxa vara (9%-28%) is another drawback of free fibular grafting and muscle pedicle grafting [1,22,25,28]. Abduction osteotomy has been suggested for coxa vara and leg-length discrepancy at a later stage after fracture union [25].…”

“…5). A union rate of 72% to 82% has been reported with muscle pedicle bone grafting [1,22]. Three of the four fractures with greater than 90 days duration failed to unite [22].…”

“…In light of complications associated with other methods for treatment of neglected femoral neck fractures, we attempted to answer three questions in our retrospective cohort study: (1) What is the role of the modified Pauwels' intertrochanteric osteotomy in neglected femoral neck fractures in adults regarding union and functional outcome? (2) Can an osteotomy correct the nonunion, limblength discrepancy, coxa vara, and avoid AVN of the femoral head, associated with other methods of treatment?…”

Valgus intertrochanteric osteotomy for neglected femoral neck fractures in young adults

“…Similar examples, often associated with delayed presentation of these fractures in developing countries, also tax the ingenuity and imagination of orthopaedic surgeons. In this situation the need to preserve the femoral head has led to the development of various procedures such as valgus osteotomy [11,13], fibular grafts [12], muscle pedicle grafts [2,10] and vascularised bone grafts [3,6]. Some of these procedures are very timeconsuming and require considerable expertise and technical competence.…”