A neglected femoral neck fracture is one where there has been a delay of more than 30 days to seek medical help from the time of the original injury. Among the spectrum of femoral neck fractures, the neglected fracture in a young adult (age <60 years) is one of the most challenging to treat if femoral head salvage is attempted.The main complication is avascular necrosis (AVN) of the femoral head with most reported incidences being <15% (range 0% to 67%), which is similar to the complication rate with non-neglected femoral neck fractures.This review consolidates our current knowledge about the problem, discusses the various treatment options and compares the published long-term results.There are no clear guidelines for management of neglected femoral neck fractures, although multiple methods have been used with varying success. Bone grafting or internal fixation in isolation does not provide a satisfactory outcome. Osteotomy has given better outcomes (AVN 6% to 17%, non-union 0% to 15%), but mechanical changes at the femoral neck may lead to a persistent painful hip. Bone grafting with internal fixation has emerged as a reliable method with good long-term functional outcomes.

Neglected femoral fractures in young adults are a challenge to the orthopaedic surgeon, requiring prolonged treatment and with attendant risks of nonunion. We postulated treatment in this group by accurate reduction, two cannulated screws, and whole free fibular autograft would allow early mobilization and provide good bony union. Thirty-two patients aged 18 to 50 years were treated at our center in this manner. They presented to our center 3 to 6 months after injury, and had Garden's Grade III/IV fractures with varying degrees of neck resorption, but no avascular necrosis. No plaster was applied, and early return to function was encouraged. Bony union was achieved in 29 (90.6%) patients at a mean of 19.2 weeks (range, 16-24 weeks). All patients with union had good function at long-term followup at an average of 6.1 years postoperatively (range, 2-12 years), and the average Harris hip score was 87.1 points (range, 74.5-94 points). Our procedure allows early return of function in young, active patients disabled by old femoral neck fractures compounded by lack of early treatment.

The Ponseti and French taping methods have reduced the incidence of major surgery in congenital idiopathic clubfoot but incur a significant burden of care, including heel-cord tenotomy. We developed a non-operative regime to reduce treatment intensity without affecting outcome. We treated 402 primary idiopathic clubfeet in patients aged < three months who presented between September 1991 and August 2008. Their Harrold and Walker grades were 6.0% mild, 25.6% moderate and 68.4% severe. All underwent a dynamic outpatient taping regime over five weeks based on Ponseti manipulation, modified Jones strapping and home exercises. Feet with residual equinus (six feet, 1.5%) or relapse within six months (83 feet, 20.9%) underwent one to three additional tapings. Correction was maintained with below-knee splints, exercises and shoes. The clinical outcome at three years of age (385 feet, 95.8% follow-up) showed that taping alone corrected 357 feet (92.7%, 'good'). Late relapses or failure of taping required limited posterior release in 20 feet (5.2%, 'fair') or posteromedial release in eight feet (2.1%, 'poor'). The long-term (> 10 years) outcomes in 44 feet (23.8% follow-up) were assessed by the Laaveg-Ponseti method as excellent (23 feet, 52.3%), good (17 feet, 38.6%), fair (three feet, 6.8%) or poor (one foot, 2.3%). These compare favourably with published long-term results of the Ponseti or French methods. This dynamic taping regime is a simple non-operative method that delivers improved medium-term and promising long-term results.