title: Revision internal fixation and nonvascular fibular graft for femoral neck nonunion.
abstract: BACKGROUND
  The rates of nonunion after internal fixation for femoral neck fractures have been reported to range from 0% to 59%. Existing treatment options are osteotomy (with or without graft), osteosynthesis using various implants and grafting techniques (muscle pedicle, vascularized, and nonvascularized fibula), or arthroplasty. The objective of this study was to assess the outcome results of revision internal fixation and nonvascular fibular bone grafting for symptomatic aseptic femoral neck nonunion.
  
  
  METHODS
  This is a retrospective case series study involving 17 patients with symptomatic femoral neck nonunion that were treated with revision internal fixation and fibular bone graft. The inclusion criteria were aseptic symptomatic femoral neck nonunion with no or minimal varus alignment. There were eight men and nine women. The average age was 46 years (range, 24-58 years). Thirteen patients had autogenous fibular bone graft, and six patients had fibular allograft.
  
  
  RESULTS
  Of the 13 patients who had autogenous nonvascularized fibular bone grafts, four remained in nonunion. Fibular autograft had a 69.2% success rate with the mean time to union 4.8 months. Four of the six patients who had fibular allografts remained in nonunion. Fibular allograft had a 33.3% success rate with the mean time to union 13.3 months.
  
  
  CONCLUSIONS
  This study showed that revision internal fixation and fibular autograft have resulted into a better and faster union rate than fibular allografts.
authors.affiliation: Department of Orthopaedic Surgery, University of Toledo, Toledo, Ohio 43614-5807, USA. hkelgafy@aol.com
authors.forename: Hossein
authors.initials: H
authors.lastname: Elgafy
authors.forename: Nabil A
authors.initials: NA
authors.lastname: Ebraheim
authors.forename: Harold Gregory
authors.initials: HG
authors.lastname: Bach
mesh_terms: D000328:Adult; D001863:Bone Screws; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D005360:Fibula / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods; D013997:Time Factors; D014184:Transplantation, Homologous / Q000379:methods; D055815:Young Adult