Treatment of femoral neck nonunion with a new fixation construct through the Watson-Jones approach

Abstract

ObjectiveThe aim of the study is to explore the clinical effect of a dynamic condylar screw (DCS) system, medial anatomical buttress plate (MABP), and autogenous iliac bone graft through the Watson-Jones approach in the treatment of femoral neck nonunion.MethodsThis prospective study included 15 patients (12 men and 3 women) with nonunion of femoral neck fracture, who were treated with the DCS and MABP with autogenous iliac bone graft through the Watson-Jones approach. The patients were followed up for an average of 16 months (range, 12–24 months).ResultsAll patients achieved bone healing with an average fracture healing time of 3.4 months (2.8–4.6 months). The Harris score significantly increased from 30 ± 3.9 before the operation to 87.6 ± 7.9 at the last follow-up, and the visual analogue scale significantly decreased from 4 ± 1.3 before the operation to 1 ± 1.7 at the last follow-up. The average limb shortening was reduced from 1.8 cm (range, 0–3.1 cm) before the revision operation to 0.5 cm (range, 0.1–1.3 cm) after the last follow-up. The neck-shaft angle of the injured side was restored from an average of 118° (range, 108–139°) before the revision operation to an average of 132° (range, 127–144°) at the last follow-up. No collapse of the femoral head, wound infections, screw backout, screw or plate breakages, or nerve injury was found.ConclusionTheDCS and MABP with autogenous iliac bone graft through the Watson-Jones approach is an effective option for the treatment of femoral neck nonunion or delayed healing.The translational potential of the articleThis article shows that the application of DCS and MABP provides a rigid fixation at the fracture site to promote bone graft integration and bone union. This new kind of technique could be one option of Hip conservation procedures, just special for young patients with femoral neck nonunion.

Prediction of osteoporosis from proximal femoral cortical bone thickness and Hounsfield unit value with clinical significance

“…We believed that this difference mainly resulted from the intertrochanteric region, as the separation zone between the cortical and cancellous bone of the proximal femur, was more sensitive to deterioration of bone quality. In addition, Tang et al (11,(20)(21)(22) proposed the "triangular stability theory" of the proximal femur and pointed out that the proximal femur was stabilized by a structural mechanical model formed by the medial, lateral, and upper sides. The ROI 14 was located at the cortex of the vastus lateralis ridge, which was the junction between the lateral and upper sides.…”

Is the reconstruction of medial support important for revision following failed treatment of femoral trochanteric fractures? a retrospective comparative study

“…Therefore, given the potential benefits associated with the reconstruction of medial support, MABP, as a specific implant that restores the medial support of the hip, has been designed and successfully applied to the treatment of femoral neck fracture and nonunion [24,25]. Hence, to furtherly evaluate the importance of medial support reconstruction in hip-preserving revision surgery following failed treatment of inter/peri-trochanteric fractures, we conducted the present study.…”

Treatment of ipsilateral femoral neck and shaft fracture by augmented fixation via modified anterior approach: A case report

“…2 -c), the fracture site of the femoral neck was exposed, and two cephaloscrews were placed after confirming that the reduction was satisfactory. To counteract the high vertical shear force and compressive stress, the medial anatomical buttress plate (MABP) (ZhengTian Medical Instrument Co. Ltd., Tianjin, China) was used to fix the femoral neck fracture [6] , [7] .…”