Management of ununited intracapsular femoral neck fractures by using quadratus femoris muscle pedicle bone grafting in young patients

Vallamshetla, V.R.P.; Sayana, Murali Krishna; Vutukuru, Ravindranath

doi:10.3944/aott.2010.2371

Cited by 13 publications

(9 citation statements)

References 15 publications

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“…Later, fresh autogenous cancellous iliac bone chips combined with muscle pedicle bone grafting were reported with good outcome 11–15…”

Section: Introductionmentioning

confidence: 99%

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

Bhuyan

2012

IJOO

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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.

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“…Later, fresh autogenous cancellous iliac bone chips combined with muscle pedicle bone grafting were reported with good outcome 11–15…”

Section: Introductionmentioning

confidence: 99%

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

Bhuyan

2012

IJOO

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“…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 …”

Section: Discussionmentioning

confidence: 99%

“… 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. [ Table 1 ] The average age was 35.58 years ( n = 198) in series where the mean age was described.…”

Section: R Esultsmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of neglected femoral neck fracture

Jain

Mukunth

Srivastava

2015

IJOO

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Intra-capsular femoral neck fractures are seen commonly in elderly people following a low energy trauma. Femoral neck fracture has a devastating effect on the blood supply of the femoral head, which is directly proportional to the severity of trauma and displacement of the fracture. Various authors have described a wide array of options for treatment of neglected/nonunion (NU) femoral neck fracture. 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 attempt to suggest treatment guides for neglected femoral neck fracture. We conducted the “Pubmed” search with the keywords “NU femoral neck fracture and/or neglected femoral neck fracture, muscle-pedicle bone graft in femoral neck fracture, fibular graft in femoral neck fracture and valgus osteotomy in femoral neck fracture.” A total of 203 print articles were obtained as the search result. Thirty three articles were included in the analysis and were categorized into four subgroups based on treatment options. (a) treated by muscle-pedicle bone grafting (MPBG), (b) closed/open reduction internal fixation and fibular grafting (c) open reduction and internal fixation with valgus osteotomy, (d) miscellaneous procedures. The data was pooled from all groups for mean neglect, the type of study (prospective or retrospective), classification used, procedure performed, mean followup available, outcome, complications, and reoperation if any. The outcome of neglected femoral neck fracture depends on the duration of neglect, as the changes occurring in the fracture area and fracture fragments decides the need and type of biological stimulus required for fracture union. In stage I and stage II (Sandhu's staging) neglected femoral neck fracture osteosynthesis with open reduction and bone grafting with MPBG or Valgus Osteotomy achieves fracture union in almost 90% cases. However, in stage III with or without AVN, the results of osteosynthesis are poor and the choice of treatment is replacement arthroplasty (hemi or total).

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“…There are varied autogenous grafting procedures using muscle pedicle graft (18-19-20) or ﬁbular graft (5, 8, 9) described to treat this difficult condition. The principle of these procedures gives impetus to revascularisation, which aids in fracture healing.…”

Section: Discussionmentioning

confidence: 99%

Vascularised Iliac Bone Grafting in the Treatment of Femoral Neck Nonunion in Young Adults: A Retrospective Study

2015

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Management of ununited intracapsular femoral neck fractures by using quadratus femoris muscle pedicle bone grafting in young patients

Cited by 13 publications

References 15 publications

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

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

Treatment of neglected femoral neck fracture

Vascularised Iliac Bone Grafting in the Treatment of Femoral Neck Nonunion in Young Adults: A Retrospective Study

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