Ununited fracture neck of femur treated with closed reduction and internal fixation with cancellous screw and fibular strut graft

Singh, Daria; Sharma, CS; Bansal, Mahesh Chand; Meena, DS; Asat, RP; Joshi, Narendra

doi:10.4103/0019-5413.34447

Cited by 3 publications

(11 citation statements)

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“…Nine articles reported more than 3 weeks of delay as neglected, 17 23 24 26 27 28 29 30 32 whereas remaining articles mentioned more than 6 weeks as the definition of neglected fracture. 19 25 31 However, the definition of nonunion is quite clear. 20 21 22 No evidence of progressive healing on anteroposterior and lateral radiographs and disabling hip pain within 6 months of primary fixation was considered as nonunion.…”

Section: R Esultsmentioning

confidence: 99%

“…reported open reduction (OR) 17 19 and another seven reported closed reduction (CR) of the fracture site. 22 23 28 29 30 31 32 Five articles reported CR where possible and OR when CR failed. 20 21 24 25 26 The authors supporting OR assert that by opening the nonunion site, the interposed fibrous tissue between the fracture fragments can be removed.…”

Section: R Esultsmentioning

confidence: 99%

“…An initial CR (traction in 45° flexion and then slight abduction followed by extension and internal rotation to 30–45° to bring the limb parallel to the trunk) should be attempted on a traction table. 23 24 28 29 30 31 32 When CR fails (in grossly displaced fracture with neck resorption), OR through Watson–Jones anterolateral approach must be performed. 21 24 25 26 …”

Section: R Esultsmentioning

confidence: 99%

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Nonvascularized fbular grafting in nonunion of femoral neck fracture

Trıpathy

Sen

Goyal

2016

IJOO

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Nonunion of femoral neck fractures following primary fixation and neglected femoral neck fracture in young adults is a challenging task. Every effort should be directed toward hip joint salvage in these patients. Among different available options of hip salvage, nonvascularized fibular graft (NVFG) osteosynthesis is simple, easy to perform, and a successful technique. In this review, the available literature on NVFG in neglected and nonunion femoral neck fractures has been analyzed. After review of 15 articles on NVFG, the average nonunion rate was estimated to be 7.86% (range 0–31%). Six articles that evaluated the preoperative and postoperative osteonecrosis reported improvement in 50% patients. The clinical and/or functional outcome was good to excellent in 56–96% patients following fibular osteosynthesis. Few complications such as coxa vara deformity, limb shortening, and intraarticular penetration of the graft or hardware have been reported. However, there are minimal donor site morbidities such as mild ankle pain, transient loss of toe flexors and extensors and transient lateral popliteal nerve palsy.

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Section: R Esultsmentioning

confidence: 99%

Section: R Esultsmentioning

confidence: 99%

Section: R Esultsmentioning

confidence: 99%

See 1 more Smart Citation

Nonvascularized fbular grafting in nonunion of femoral neck fracture

Trıpathy

Sen

Goyal

2016

IJOO

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show abstract

“…FIXATION TECHNIQUES: Systematic reviews still do not come to any clear conclusions on the choice of implant for internal fixation of intracapsular fractures from the available evidence within randomized trials. [13] Parallel screw fixation seems to be the most commonly used technique [1,2,3] but attention has to be put in their correct placement and even then, they are found wanting in situation of gross osteoporosis and comminution of the cortex of the neck. [5] Crossed nails or screws provide better fixation than parallel nails or screws.…”

Section: Case Historymentioning

confidence: 99%

“…Fixation of femoral neck fractures requiring fibular grafting have traditionally been done with one or two cancellous screws. [1,2,3] This type of fixation appears less desirable in the setting of osteoporosis of the trochanteric cortex, like in pathological situations. [4,5] There is very little in contemporary literature regarding use of other implants along with the fibula.…”

Section: Introductionmentioning

confidence: 99%