title: Fixation with cancellous screws and fibular strut grafts for neglected femoral neck fractures.
abstract: OBJECTIVE
  To review the outcomes of fixation with cancellous screws and fibular strut grafts for neglected femoral neck fractures.
  
  
  METHODS
  44 men and 28 women aged 17 to 50 years with neglected femoral neck fractures of the subcapital (n=12), transcervical (n=57), or basal (n=3) types underwent closed (n=39) or open (n=33) reduction and fixation with a single cancellous screw with double fibular strut grafts (n=24) or fixation with double cancellous screws with a single fibular strut graft (n=48). The mean time from injury to surgery was 10 weeks; the delay was 22 to 35 days in 43 patients and >35 days in 29 patients. Double fibular strut grafts were used for 18 patients with longer delay and resorption of the femoral neck, and 18 patients with posterior comminution of the femoral neck. The outcome was assessed using the Harris hip score.
  
  
  RESULTS
  Patients were followed up for a mean of 3 years. The time to bone union was 3 to 4 months in 48 patients, 4 to 5 months in 15, and 5 to 6 months in 5; nonunion was noted in 4 patients. In 18 patients with resorption of the femoral neck, bone union took a longer time. The Harris hip score was excellent (90-100) in 30 patients, good (80-89) in 20, fair (70-79) in 15, and poor (<70) in 7. Of the latter, 4 had nonunion and 3 developed avascular necrosis of the femoral head; they had persistent pain and restriction of hip joint movement.
  
  
  CONCLUSIONS
  Fixation with cancellous screws and fibular strut grafts for neglected femoral neck fractures is cost-effective and technically less demanding, and associated with good outcomes.
authors.affiliation: Department of Orthopaedics, SN Medical College, Agra, India.
authors.forename: Chandra Prakash
authors.initials: CP
authors.lastname: Pal
authors.affiliation: Varanasi, India.
authors.forename: Binod
authors.initials: B
authors.lastname: Kumar
authors.affiliation: Department of Orthopaedics, SN Medical College, Agra, India.
authors.forename: Karuna Shankar
authors.initials: KS
authors.lastname: Dinkar
authors.affiliation: Department of Orthopaedics, UPRIMS & R, Saifai, India.
authors.forename: Pulkesh
authors.initials: P
authors.lastname: Singh
authors.affiliation: Department of Orthopaedics, Safdarjung Hospital, New Delhi, India.
authors.forename: Harish
authors.initials: H
authors.lastname: Kumar
authors.affiliation: Department of Orthopaedics, UPRIMS & R, Saifai, India.
authors.forename: R K
authors.initials: RK
authors.lastname: Goyal
mesh_terms: D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D016025:Bone Transplantation; D005260:Female; D005265:Femoral Neck Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005360:Fibula / Q000637:transplantation*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D061665:Time-to-Treatment; D016896:Treatment Outcome; D055815:Young Adult
keywords: bone screws; bone transplantation; femoral
  neck fractures