title: Results of triple muscle (sartorius, tensor fascia latae and part of gluteus medius) pedicle bone grafting in neglected femoral neck fracture in physiologically active patients.
abstract: BACKGROUND
  Femoral neck fractures are notorious for complications like avascular necrosis and nonunion. In developing countries, various factors such as illiteracy, low socioeconomic status, ignorance are responsible for the delay in surgery. Neglected fracture neck femur always poses a formidable challenge. The purpose of this study was to evaluate the results of triple muscle pedicle bone grafting using sartorius, tensor fasciae latae and part of gluteus medius in neglected femoral neck fracture.
  
  
  METHODS
  This is a retrospective study with medical record of 50 patients, who were operated by open reduction, internal fixation along with muscle pedicle bone grafting by the anterior approach. After open reduction, two to three cancellous screws (6.5 mm) were used for internal fixation in all cases. A bony chunk of the whole anterior superior iliac spine of 1 cm thickness, 1 cm width and 4.5 cm length, taken from the iliac crest comprised of muscle pedicle of sartorius, tensor fascia latae and part of gluteus medius. Then the graft with all three muscles mobilized and put in the trough made over the anterior or anterosuperior aspect of the femoral head. The graft was fixed with one or two 4.5 mm self-tapping cortical screw in anterior to posterior direction.
  
  
  RESULTS
  14 patients were lost to followup. The results were based on 36 patients. We observed that in our series, there was union in 34, out of 36 (94.4%) patients. All patients were within the age group of 15-51 years (average 38 years) with displaced neglected femoral neck fracture of ≥30 days. Mean time taken for full clinicoradiological union was 14 weeks (range-10-24 weeks).
  
  
  CONCLUSIONS
  Triple muscle pedicle bone grafting gives satisfactory results for neglected femoral neck fracture in physiologically active patients.
authors.affiliation: Department of Orthopaedics, Gandhi Medical College and Hamidia Hospital, Bhopal, Madhya Pradesh, India.
authors.forename: Pankaj Kumar
authors.initials: PK
authors.lastname: Mishra
authors.affiliation: PRITI Nursing Home, Allahabad, Uttar Pradesh, India.
authors.forename: Anuj
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Orthopaedics, Gandhi Medical College and Hamidia Hospital, Bhopal, Madhya Pradesh, India ; PRITI Nursing Home, Allahabad, Uttar Pradesh, India.
authors.forename: Suresh Chandra
authors.initials: SC
authors.lastname: Gaur
keywords: Avascular necrosis; Avascular necrosis of bone; bone screws; femoral neck fractures; grafting; neglected femoral neck fracture; nonunion; triple muscle pedicle bone graft