Outcome of fibular strut graft and two cannulated hip screws in neglected fracture neck of femur in adults - 10 years review

Abstract

Introductions: Avascular necrosis and non-union are common but when the neck of femur fracture in adult is neglected, the chances of complications rises. Among various treatment options, we report the outcome of free fibular strut graft along with two cannulated hip screws in neglected fracture neck of femur.
 Methods: The outcome analysis of ‘fibular strut graft and two cannulated hip screws’ was conducted in patients with fracture neck of femur who presented at least three weeks after the time of injury, during August 2008 to December 2017, at Lumbini Zonal Hospital and Lumbini Hospital Technical College, Butwal, Nepal. All adult patients aged 18 to 60 years were included. Outcome variables were healing of fracture (union, delayed union, non-union), avascular necrosis and Harris Hip Score (HHS).
 Results: Out of 20 fractures, 17 (85%) united uneventfully, 2 (10%) had delayed union and 1 (5%) nonunion. We had 3 (15%) avascular necrosis of femoral head. The HHS was excellent in 8 (40%), good in 4 (20%), fair in 6 (30%) and poor in 2 (10%).
 Conclusions: Fibular Strut graft with two hip screws resulted in fracture union and improved hip functions in patients with neglected fracture of neck of femur.

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

“…4 Half of the studies summarized in this review are treating neglected femoral neck fractures. 8,10,12 These fractures remain a burden in developing countries. Neglected femoral neck fracture presents with shortening, severe external rotation of the lower extremity, upward displacement of the trochanter, with or without soft tissue contracture.…”

“…Seven patients had minor complains such as mild ache, ankle swelling after rigorous walking, and some weakness of long toe flexors and extensors Zahid et al 9 6 0 Other complications include screw migration in the joint space (1), graft migration into the joint space (3), and screw pullout (5). Chhetri et al 10 1 3 Complications were reported three weeks after intervention, including shortening (5), hip screws backing out (3), head cut through by screw (1), varus alignment (1), late infection (1), superficial infections (3), and donor site discomfort (4). Elgeidi et al 11 1 0 Pain was the most common morbidity in patients (7), which settled down in 2 months.…”

“…The procedure is simple and effective with high rate of fracture union, painless, stable and mobile hip. 8,10,24 Meanwhile, another half of the studies were treating fresh femoral neck fractures. 9,11,13 Two of the papers specifically studied about another issue regarding femoral neck fractures which is displaced fractures, mainly posterior comminution.…”