Neglected Femoral Neck Fractures in Adults

Abstract

Purpose. To assess treatment outcomes in adults with neglected femoral neck fractures, and propose a treatment protocol based on bone quality measured by the Singh index. Methods. 16 men and 6 women aged 18 to 48 (mean, 33) years presented with neglected (>3 weeks old) femoral neck fractures. Those with good bone quality (Singh index, >3) underwent closed reduction and valgus osteotomy and fixation with 120º double angle blade plates (group 1, n=8), whereas those with poor bone quality (Singh index, <3) and/or communition of the posterior femoral neck underwent fibular grafting and internal fixation with one or two 7-mm cannulated cancellous screws (group 2, n=14). Functional outcome was assessed at the 6-month follow-up, according to modified Askin and Bryan criteria. 2011;19(1):13-7 4-21) weeks. Patients were followed up for a mean of 19 (range, 12-24) months. The mean time to union was 20 (range, 12-52) weeks. The mean time to full weight bearing was 18 (range, 12-40) weeks. All patients achieved bone union except one in group 1 who had non-union and breakage of the blade plate at week 20 and underwent total hip arthroplasty. Other complications included slippage of fibular graft (n=1), delayed union (n=1), avascular necrosis of the femoral head (n=2, Fig. 6), limb length discrepancy (n=3), and superficial infection (n=1). Functional outcome was excellent in 2 patients, good in 17, and poor in 3. Conclusion. Valgus osteotomy and double angle blade plate fixation, and fibular grafting and cancellous screw fixation appeared to be appropriate treatments for neglected femoral neck fractures in adults. Journal of Orthopaedic Surgery

Comparative study of fresh femoral neck fractures managed by multiple cancellous screws with and without fibular graft in young adults

“…2,3 As insertion of fibular strut graft offers advantage of stability, osteoinductive and osteoconductive properties thus enhancing union, 8 it also prevents avascular necrosis 9 and collapse of head of femur. 10,11 Moreover it is technically easy to harvest the graft. Lateral radiograph of hip is not very sensitive to show the posterior comminution of neck and displaced fractures, Garden type III and IV are definitely associated with posterior comminution.…”

Outcome of fibular strut graft and two cannulated hip screws in neglected fracture neck of femur in adults - 10 years review

“…5,6 Treatment options include valgus osteotomy with or without bone graft and osteosynthesis using various implants and bone grafting techniques (muscle pedicle, vascularized, or free fibula) with variable outcome, union rate of 60-95%. 2,3,5 Osteosynthesis approaches help achieve union. McMurray or valgus trochanteric osteotomy alter the biomechanics of hip, decreasing abductor lever arm thus creating a possible limp.…”

“…Results varies among various modalities to achieve osteosynthesis in order to salvage the head, for example, the muscle pedicle bone grafting, avascular or vascular fibular grafting, varieties of osteotomies along with various implants. [2][3][4] There is no agreed uniform modality to address the problem, accuracy of reduction and rigidity of fixation affects the final outcome. 5,6 We analyzed the result of free fibular strut graft along with two cannulated cancellous screws in fracture neck of femur presenting late, three weeks or more from initial trauma.…”

Combination of modified free vascularized fibular grafting and reverse Less Invasive Stabilization System (LISS) for the management of femoral neck nonunion in patients thirty years of age or younger

“…In addition, complete debridement between the fragments will encourage vascularization across the nonunion site. More importantly, the combination of lateral reverse LISS fixation and the anterior vascularized fibular graft achieved both the rotational stability and enhanced fracture biology [40,41]. The vascularized fibular grafts helped both in fracture stability and healing [42].…”