Augmented osteosynthesis with tensor fascia latae muscle pedicle bone grafting in neglected femoral neck fracture

Abstract

Background:Neglected intracapsular femoral neck fracture in young patients may fail to unite because of the excessive shearing strain at the fracture site and it is a surgical challenge to any orthopedic surgeon. The problem is compounded by resorption of the femoral neck and avascular necrosis (AVN) of femoral head. There is no satisfactory solution available in the management of femoral neck fracture as far as the union of the fracture and AVN of femoral head are concerned. Muscle pedicle bone grafting has been advocated to provide additional blood supply to the femoral head. We report a retrospective analysis of 48 cases of neglected femoral neck fracture treated by internal fixation and tensor fascia latae based muscle pedicle bone grafting.Materials and Methods:48 patients with femoral neck fractures with age varied from 20 to 53 years (average age 32.9 years) with male to female ratio of 2:1 were enrolled. All fractures were more than 3 weeks old with mean delay being 86 days (22–150 days). Open reduction and internal fixation along with tensor fascia latae muscle pedicle bone grafting was done in all cases. It was supplemented by multiple drilling and cortico-cancellous bone grafting. Fracture fixation was done with three parallel 6.5-mm AO cannulated cancellous lag screws and the graft fixed with a 4-mm cancellous screw to provide a secure fixation. During the followup period of 2-6.8 years (average 4.4 years) the results were assessed clinically by modified Harris hip scoring system and radiologically by the evidence of signs of fracture union.Results:Union was achieved in 41/48 (85.41%) cases which were followed for an average period of 4.4 years (2–6.8 years) with good functional results and ability to squat and sit cross-legged. Results were assessed according to modified Harris Hip Scoring system and found to be excellent in 19, good in 22, fair in 5, and poor in 2 patients. Complications were nonunion, (n=3) avascular necrosis (n=2), and coxa vara deformity (n=2).Conclusion:Internal fixation with muscle pedicle bone grafting is a suitable option to secure union in neglected femoral neck fractures in physiologically active patients with late presentation.

Results of triple muscle (sartorius, tensor fascia latae and part of gluteus medius) pedicle bone grafting in neglected femoral neck fracture in physiologically active patients

“…neck length) distance along with augmentation of vascularity of neck of femur are the mainstay of treatments in neglected femoral neck fractures in young adults. Muscle pedicle graft provides further blood supply to the femoral head by acting as a vascular inlay graft, so it enhances the osteosynthesis if used along with internal fixation in neglected femoral neck fracture 17. Quadratus femoris muscle pedicle graft was first time used by the Judet, to treat these fractures.…”

Treatment of neglected femoral neck fracture

“…Tensor Fascia Lata and Gluteus medius based MPBG is done in lateral or supine position by lateral or anterolateral approach. 5 6 7 8 9 10 …”

“…Six full papers and two abstract were analyzed. 4 5 6 7 8 9 10 11 Seven studies 4 5 6 8 9 10 11 were prospective, and 1 was retrospective. 7 These studies included 368 patients.…”

“…Various authors have described a wide array of options for treatment of neglected/NU femoral neck fracture. 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 There is lack of consensus in general, regarding the best option. This instructional course article is an analysis of available treatment options used for neglected femoral neck fracture in the literature and an attempt to suggest treatment guidelines for neglected femoral neck fracture.…”

Role of muscle pedicle bone graft as an adjunct to open reduction and internal fixation in the management of neglected and ununited femoral neck fracture in young adults: a prospective study of 17 cases

“…This procedure could be undertaken even when the neck shows appreciable resorption and in cases with osteonecrotic changes in the head [3]. We preferred this technique as most of our patients came to us after a long period of delay in treatment, and the muscle pedicle bone graft acted as a viable vascular inlay graft, encouraging osteosynthesis and revascularisation of the femoral head [11].…”