Fibular strut graft for nonunited femoral neck fractures in children

Elgeidi, Adham; El-Negery, Abed

doi:10.1302/1863-2548-11-160221

Cited by 16 publications

(15 citation statements)

References 30 publications

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“…The average delay in the presentation after the fracture ranges from 5 weeks to 70 weeks. The In our present study, because of the delay in intervention and the young age of patients, Pauwels' osteotomy was performed as the head-salvaging procedure [14]. In the present study, because of the Surgical Review: International Journal of Surgery Trauma and Orthopedics 2020;6(5)…”

Section: Methodsmentioning

confidence: 88%

Management of Old Neck Femur Fracture through Valgus Osteotomy and Pin Fixation

Rathod

Chauhan

2020

Int J Surg Ortho

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Introduction: Valgus intertrochanteric osteotomy alters the biomechanical environment of thefracture site and restores limb length. Very few reports have dealt with the results of this procedureinternally fixed with a dynamic hip screw and double angle barrel plate. Hence, the prospectivestudy was performed at the institution level for the evaluation of results of valgus osteotomy andfixation of the femur neck fracture in young patients. Material and Methods: A total of 32 patientswere included in the study. There were 24 males and 8 females in the study. Before osteotomy, theaverage neck-shaft angle was 101° (80–120°), with an average limb shortening of 2.3cm (1.0–3.2cm). The greater trochanter was up riding in fourteen cases and needed skeletal traction beforesurgery. None of these had evidence of vascular necrosis on plain radiograph or MRI. The fractureswere treated with a dynamic hip screw and double angle barrel plate. The patients had a minimumfollow-up of 14months and a maximum of 42months. Results: In a total of 28 patients the excellentresults were obtained, however in 4 patients the poor result was due to cut – out of implants. Noneof the patients were lost on follow up, the fracture went on to achieve the satisfactory union afterthe minimum of 14 weeks follows up. The average preoperative neck-shaft angle of 101° (range 80–120°) increased to 134° (range 120–145°) after surgery. The average limb length discrepancypostoperatively was 2.3cm. Conclusion: From the study, it was concluded that valgus osteotomyand fixation with dynamic hip screw and 120° double angle barrel plate has a high success rate inyoung patients with neglected and ununited intracapsular fracture neck of the femur as far as theunion of fracture is concerned.

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Section: Methodsmentioning

confidence: 88%

Management of Old Neck Femur Fracture through Valgus Osteotomy and Pin Fixation

Rathod

Chauhan

2020

Int J Surg Ortho

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“…The clinical outcomes of the patients are summarized in Table 2. The fractures were classified with Garden grades II-IV (9,(12)(13)(14) and Pauwels classification I-III. 12 Most of the fibular strut graft interventions were also complemented with hip screws.…”

Section: Clinical Outcomesmentioning

confidence: 99%

A Systematic Review On The Outcomes Of Fibular Strut Graft For Femoral Neck Fractures In Adults

Soetjahjo

Nefihancoro

Ermawan

et al. 2021

BHSJ

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Introduction: Femoral neck fractures are a type of intracapsular hip fracture which also be found in younger patients who suffered from high-energy trauma such as vehicle accidents. Non-union and avascular necrosis are the most frequent complications following femoral neck fractures. In this study, we reviewed the outcomes of fibular grafting techniques for femoral neck fractures in adults.Method: Online libraries PubMed, Cochrane Library and Scopus were searched for relevant papers. We searched for scientific publications published between 2009 and 2020. Inclusion and exclusion criteria were used, and prespecified characteristic were extracted from each study.Result: We found 172 papers relevant to the topic. At last, we included 6 papers in this systematic review with a total of 198 patients. Fibular strut graft for femoral neck fractures have shown excellent outcomes, uniting 177 (89,39%) of 198 fractures reviewed. Overall, 15 patients (7,57%) experiencing non-union and 12 patients (6,06%) having avascular necrosis.Conclusion: The outcomes of the intervention turned out to be excellent, assessed by both functional outcome criteria and radiographic bony union. It is important to established a consensus on surgical intervention for femoral neck fractures, specifically including fibular strut grafting.

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“…12,15 However there is consensus for choosing stability of fixation over preservation of physis and for using screws across the physis if required to get a stable fixation. 7,8,17,39 This is based on the observation that amount of shortening due to physeal arrest is not significant in majority of cases (average 1.5e2 cm) and does not affect functional outcome. An unstable fixation may lead to more severe complications like AVN, nonunion and coxa vara.…”

Section: Crossing Of Physismentioning

confidence: 99%

Current controversies in management of fracture neck femur in children: A review

Pandey

John

2020

Journal of Clinical Orthopaedics and Trauma

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Paediatric femur neck fracture is an uncommon injury and is known for high rate of complications. This in turn, can have significant impact on development of hip and overall function of the child. Controversy prevails in many areas of management and it still remains a difficult injury to manage. Through this paper, an attempt has been made to summarize the current concepts in management and suggest current recommendations regarding the controversies so that these injuries can be managed judiciously. A systematic review was done as per PRISMA guidelines using pre-defined inclusion and exclusion criteria. 18 studies with better scientific evidence after quality assessment were included in the systematic review. Current trends and Controversial issues in management were then identified and discussed. It was observed that existing literature is inconclusive regarding several aspects of management of this injury with no clear guideline available. However, certain recommendations useful for decision making could be made. These injuries should be managed aggressively with operative fixation at the earliest and one should not hesitate to open reduce if acceptable alignment is not obtained after one or two gentle closed manipulations. Choice of implant and their configuration in neck can vary depending on age and weight of patient, type of injury and surgeon's preference. Initial fracture displacement could be considered to be most predictive for development of osteonecrosis of the femoral head, whereas, role of surgical decompression, type of fixation and timing of surgery is still debatable. Functional outcome is primarily affected by osteonecrosis of the femoral head, nonunion and severe coxa vara, whereas mild coxa vara, shortening, and premature closure of physis when considered alone, don't have significant influence on functional outcome in short term. Treatment of fracture neck femur in children is still controversial in many aspects and needs further research. It should be understood that complications can occur regardless of the method of treatment and might reveal their full impact many years after injury. Hence, a guarded prognosis should be explained to the parents and care-givers at the time of injury.

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Fibular strut graft for nonunited femoral neck fractures in children

Cited by 16 publications

References 30 publications

Management of Old Neck Femur Fracture through Valgus Osteotomy and Pin Fixation

Management of Old Neck Femur Fracture through Valgus Osteotomy and Pin Fixation

A Systematic Review On The Outcomes Of Fibular Strut Graft For Femoral Neck Fractures In Adults

Current controversies in management of fracture neck femur in children: A review

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