The management of ununited fractures of the femoral neck using internal fixation and muscle pedicle periosteal grafting

Gupta, Ajay Kumar

doi:10.1302/0301-620x.89b11.19298

Cited by 21 publications

(21 citation statements)

References 40 publications

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“…Other disadvantages include the difficulty of accurate correction of coxa (10). A quadratus femoris muscle pedicled myoperiosteal flap has also been employed to treat un-united fractures of the femoral neck in 20 patients with a satisfactory outcome (12). However, the number of cases was quite limited, and the posterior approach risks damage to the deep branch of the medial femoral circumflex artery and may cause intragenic osteonecrosis of the femoral head (19,20).…”

Section: Discussionmentioning

confidence: 99%

“…Prosthetic replacement generally is the preferred treatment for patients older than 60 years, while attempts to salvage of the femoral head are generally favoured for younger patients. A variety of surgical procedures, such as valgus osteotomy (1,2,6), muscle pedicle bone graft (10,11) or periosteal graft (12,13), nonvascularised bone graft (3,4,14) and…”

Section: Introductionmentioning

confidence: 99%

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Free Vascularised Fibular Graft for Neglected Femoral Neck Fractures in Young Adults

et al. 2012

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Neglected femoral neck fractures in young adults pose a great challenge to orthopedic surgeons because of the high risks of nonunion and osteonecrosis. We attempted to determine whether free vascularised fibular grafting through an anterior approach could enhance bone union, improve hip function and reduce complications in the treatment of such fractures. Thirteen patients with neglected femoral neck fractures were treated with a free vascularised fibular graft through an anterior approach between 2004 and 2008. The mean age was 30.9 years (range, 17-47 years). The average delay between injury and operation was 6.7 months (range, 1.5-22 months). All 13 cases had ununited fractures but without osteonecrosis of the femoral head on plain radiographs before coming under our care. The average follow-up was 51.2 months (range, 36-75 months). All patients had fracture union within an average of 4.8 months (range, 3-9 months). Postoperatively, 9 patients had coxa vara of 10 to 20 degrees and leg discrepancy between 0.5 to 1.5 cm. One patient had coxa vara deformity of 25 degrees and 2-cm leg discrepancy. No patients developed osteonecrosis of the femoral head or donor-site morbidity. The mean Harris hip score improved from 55.5 points preoperatively to 84.8 points postoperatively (p<0.01). This procedure may be useful and safe in the treatment of neglected femoral neck fractures in young adults, but further studies with a large number of patients are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Free Vascularised Fibular Graft for Neglected Femoral Neck Fractures in Young Adults

et al. 2012

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“…The pronator quadratus flap inspired from the use of musculoperiosteal flaps for old fracture neck femur10 was used by us for three reasons: 1) to increase the vascularity of scaphoid; 2) it also provided a bone graft which hastens its fracture union; and 3) it was used to augment the partially ruptured volar radioscaphocapitate ligament. At the final followup, the lunate was relatively volar flexed on the lateral view but the lunocapitate angle was 12° [Figure 6a]; this might be the reason for decreased dorsiflexion.…”

Section: Discussionmentioning

confidence: 99%

“…The osteoperisosteal muscular flap was then attached across the scaphoid fracture site and the proximal muscle sleeve's distal part was sutured to the partially ruptured volar radioscaphocapitate ligament as an augment [Figure 4]. Use of musculoperiosteal flaps in fracture neck femur has given good results;10 the same principle prompted us to use such a procedure for fracture scaphoid in our case. Lunotriquetral ligament repair was not possible due to old nature of injury, but augmentation was done by dorsal capsulodesis and adjacent extensor indicis tendon flap.…”

Section: Case Reportmentioning

confidence: 96%

Two stage procedure for neglected transscaphoid perilunate dislocation

Lal

Jangira

Kakran

et al. 2012

IJOO

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We report a two-staged surgical procedure for neglected 3 month old volar transscaphoid, transcapitate perilunate fracture dislocation wrist in an 18 year old right handed male student. The lunate with proximal scaphoid and proximal capitate maintained its articulation with distal end radius while the rest of carpal bones had dislocated volarly. In the first stage, bilateral uniplanar wrist distractor was applied with the aim of stretching soft tissue. In the next stage open reduction and internal fixation was done by a combined volar and dorsal approach augmented by pronator quadratus flap. At 3 years followup the patient was pain free and had a full range of supination pronation of the forearms and radial and ulnar deviation of wrist with 10° dorsiflexion deficit.

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“…Nonunion and avascular necrosis (AVN) have remained as the major complications following femoral neck fractures with a range of 10 to 20% 123. Despite improvements in techniques of surgery and internal fixation devices, Neglected nonunion of femoral neck fracture is common in the developing world 12.…”

Section: Introductionmentioning

confidence: 99%

Transfracture abduction osteotomy: A solution for nonunion of femoral neck fractures

Pingle¹

2014

IJOO

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Background:Nonunion and avascular necrosis (AVN) of the femoral head remains one of the major complications following femoral neck fractures. Despite various surgical techniques and internal fixation devices, the incidence of nonunion and AVN has remained unsolved. Neglected nonunion of femoral neck fracture is common in the developing world. Treatment options include rigid internal fixation with or without bone grafting, muscle pedicle bone graft, valgus osteotomy of the proximal femur with or without bone graft, valgus osteotomy or hip arthroplasty. We conducted a retrospective analysis of cases of nonunion of femoral neck fracture treated by transfracture abduction osteotomy (TFAO).Materials and Methods:Over a period of 35 years (1974-2008), 30 patients with nonunion of femoral neck fractures were treated with TFAO over a period of 35 years (1974-2008), All patients were less than 50 years of age. Absence of clinical and radiological signs of union after four months was considered as nonunion. Patients more than 50 years of age were excluded from the study. Union was assessed at 6 months radiologically. Limb length was measured at six months. The mean duration of femoral neck fracture was 19 months (range 4 months 10 years). Results were analyzed in terms of radiological union at six months. Average followup was five years and six months.Results:Consistent union was noted at the followup after six months in 29 cases. One case was lost to followup after five and one-half months postoperatively. However, the fracture had united in this case at the last followup. Average shortening of the limb at six months was 1.9 cm. Average neck shaft angle was 127° (range 120-145°). Five cases went into AVN but were asymptomatic. Two cases required reoperation due to back out of Moore's pins. These were reopened and cancellous screws were inserted in the same tracks.Conclusions:Consistent union of nonunion femoral neck fracture was noted at the followup after six months in 29 cases. The major drawback of the procedure is immobilization of the patient in the hip spica for eight weeks.

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The management of ununited fractures of the femoral neck using internal fixation and muscle pedicle periosteal grafting

Cited by 21 publications

References 40 publications

Free Vascularised Fibular Graft for Neglected Femoral Neck Fractures in Young Adults

Free Vascularised Fibular Graft for Neglected Femoral Neck Fractures in Young Adults

Two stage procedure for neglected transscaphoid perilunate dislocation

Transfracture abduction osteotomy: A solution for nonunion of femoral neck fractures

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