Free vascularised fibular graft for post-traumatic osteonecrosis of the femoral head in teenage patients

Abstract

Free vascularised fibular grafting has been reported to be successful for adult patients with osteonecrosis of the femoral head (ONFH). However, its benefit in teenage patients with post-traumatic ONFH has not been determined. We evaluated the effectiveness of free vascularised fibular grafting in the treatment of this condition in children and adolescents. We retrospectively analysed 28 hips in 28 patients in whom an osteonecrotic femoral head had been treated with free vascularised fibular grafting between 2002 and 2008. Their mean age was 16.3 years (13 to 19). The stage of the disease at time of surgery, and results of treatment including pre- and post-operative Harris hip scores, were studied. We defined clinical failure as conversion to total hip replacement. All patients were followed up for a mean of four years (2 to 7). The mean Harris hip score improved from 60.4 (37 to 84) pre-operatively to 94.2 (87 to 100) at final follow-up. At the latest follow-up we found improved or unchanged radiographs in all four initially stage II hips and in 23 of 24 stage III or IV hips. Only one hip (stage V) deteriorated. No patient underwent total hip replacement. Free vascularised fibular grafting is indicated for the treatment of post-traumatic ONFH in teenage patients.

Early results of a novel technique using multiple small tantalum pegs for the treatment of osteonecrosis of the femoral head

“…Pre-and post-operative mean clinical scores of patients whose hips deteriorated radiologically according to the Classification of the Japanese Investigation Committee of Health and Welfare (JICHW) classification post-operatively and those whose hips did not deteriorate small-size and sclerotic lesions, although it may cause weakness of the cancellous bone. 33,34 Bone grafting 4,5,7,8 or implants [11][12][13][14][15][16][17][18][19] have been used in an attempt to reinforce the femoral head following core decompression. Tantalum implants have been introduced in the last decade as an alternative to autologous bone grafting to avoid the morbidity of harvesting the graft.…”

“…[1][2][3] Hip-salvaging surgical procedures such as core decompression, vascularised or non-vascularised bone grafting and various osteotomies provide good results when lesions are small and are treated prior to collapse of the articular surface. [4][5][6][7][8][9] Total hip replacement (THR) is the only alternative at the final stage of the disease, although undesirable for young and active patients.…”

Free vascularised fibular grafts in orthopaedics

“…Only 8 % of patients needed joint replacement in one study [48], and surgery was postponed by up to seven years in 70 % of patients in another report [9]. FVFGs have also been successful in treating teenagers with posttraumatic AVN [48,49], improving Harris hip scores (HHS) from 60.4 to 94.2, and appear to give more successful outcomes than other joint-preserving procedures [48][49][50]. Ultimately, the success of FVFGs depends on AVN aetiology, stage and size [13].…”

The natural history of traumatic femur head necrosis after femoral neck fracture in children and adolescent: a retrospective case series of 64 patients

“…Numerous studies have attempted to elucidate the incidence of TFHN and the relevant risk factors, but few have provided additional information such as the characteristics of the natural history or the targeted treatment. Mirrored to the experience of adult FHN, or other childhood osteonecrosis caused by other common aetiologies, hip-preserving operations, such as core decompression [7], free vascularized-fibular grafting [8] and hip osteotomy [9], have been used without confirmed evidence. In the absence of clear guidance, surgeons failed to make timely treatment plan, and observational treatment, such as non-weight bearing exercises [5,10] or pharmacotherapy [11], were used reluctantly.…”