The Application of Closed Reduction Internal Fixation and Iliac Bone Block Grafting in the Treatment of Acute Displaced Femoral Neck Fractures

Abstract

ObjectiveThis study aimed to evaluate the preliminary clinical and radiographic outcomes of acute displaced femoral neck fracture treated by closed reduction and internal fixation (CRIF) with free iliac bone block grafting with comparison to a routine protocol of CRIF without bone grafting.MethodsFrom December 2008 to February 2010, 220 adult patients with acute displaced femoral neck fractures were enrolled in this study. In study group, there were 124 patients (57 males, 67 females) with a mean age of 44.8 years (range, 20-64 years). There were 70 transcervical fractures and 54 subcapital fractures. The patients were treated by CRIF and free iliac bone block grafting. The control group consisted of 96 adult patients (46 males, 50 females) with a mean age of 46.3 years (range, 23-64 years). There were 61 transcervical fractures and 35 subcapital fractures. The patients in control group were treated by CRIF without bone grafting.ResultsIn study group, 112 patients were followed up for an average of 27.4 months (range, 24-34 months). All fractures healed within 5 months. However, 10 patients presented AVN of the femoral heads. The mean Harris score was 88.6 (range, 41-100). In control group, 68 patients were followed up for an average of 31.2 months (range, 24-42 months). The rates of AVN of the femoral head and fracture nonunion in control group were 26.5% (18/68) and 16.2% (11/68), respectively, significantly higher than those in study group (both P<0.05). The mean Harris score in control group was 83.8 (41–100), significantly lower than that in study group (P<0.05).ConclusionAcute displaced femoral neck fractures can be treated by CRIF and free iliac bone block grafting in a minimally invasive manner. This technique can guarantee uneventful fracture healing and significantly reduce the rate of femoral head osteonecrosis.

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

“…7 In young adults fixation with multiple cancellous cannulated screws is associated with non-union (0e62%) and avascular necrosis (12e86%). 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.…”

Efficacy Evaluation for the Treatment of Subcapital Femoral Neck Fracture in Young Adults by Capsulotomy Reduction and Closed Reduction

“…Different from femoral neck fractures in elderly patients, because of strong external force with severe damaging of medial femoral circumflex artery and lateral femoral circumflex artery, young adults are more likely to develop to nonunion and ANFH. [ 9 10 11 ] Foveolar artery is barely injured, but only small area blood supply cannot prevent it. [ 15 ] For this type of fracture, accurate anatomic reduction and stable internal fixation should be achieved in principle[ 22 ] to improve blood supply as much as possible.…”

“…[ 2 3 5 6 ] What is important is that subcapital femoral neck fracture in young adults is often associated with higher incidences of nonunion and avascular necrosis of the femoral head (ANFH), which will result in a devastating outcome. [ 7 8 9 10 11 ] Although closed reduction and internal fixation have minimal invasion and short operation time,[ 12 ] it can develop those complications that result from bad reduction and fixation. [ 13 14 15 ] The selection of the proper operation method to avoid those complications is an ambiguous matter and research focus for many researchers.…”

Hypoxia in Bone and Oxygen Releasing Biomaterials in Fracture Treatments Using Mesenchymal Stem Cell Therapy: A Review

“…(C) Post-operative plain radiograph of a talus presented with a fracture. Adapted from Patel (2012) , Li et al (2013) , and Kim and Yanuck (2018) .…”