title: Triple attack technique for non-union of femoral neck fractures.
abstract: OBJECTIVE
  The purpose of this study was to describe the technique and clinical results following the utilization of biomechanical and biological means for adequate fracture healing in management of non-union of the neck of femur while preventing distortion of normal hip biomechanics.
  
  
  METHODS
  Twenty-two patients with non-united fractures of femoral neck in adults were treated with what was termed the 'triple attack' procedure. This constituted iliac autogenous bone grafting, valgus subtrochanteric osteotomy together with static fixation across the non-union fracture site of the neck to avoid delayed femoral neck shortening.
  
  
  RESULTS
  All patients were classified as Pauwel's type III fractures. The mean time interval between the last operation and the current procedure was 4.6 months. Average operative time was 58.6 minutes. Patients were followed up for an average of 43.6 months. Complete union was achieved in all cases at an average of 4.3 months. Significant improvement of all radiological parameters was noticed together with the Harris hip score from an average of 21.2 pre-operatively to 89.6 at the last follow-up.
  
  
  CONCLUSIONS
  The present study provides encouraging clinical and functional results to suggest that this newly described procedure ('triple attack') might be a valuable option in the management of non-united femoral neck fractures.
authors.affiliation: Orthopaedics Department, Cairo University, Cairo, Egypt.
authors.forename: Hazem
authors.initials: H
authors.lastname: Abdelazeem
authors.affiliation: Orthopaedics Department, Cairo University, Cairo, Egypt. ahmed.abdelazeem@kasralainy.edu.eg.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdelazeem
authors.affiliation: Orthopaedics Department, Cairo University, Cairo, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al-Dars
authors.affiliation: Orthopaedics Department, Cairo University, Cairo, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Hegazy
authors.affiliation: Orthopaedics Department, Beni Suef University, Beni Suef City, Egypt.
authors.forename: Nasef
authors.initials: N
authors.lastname: Abdellatif
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D016025:Bone Transplantation; D005260:Female; D005265:Femoral Neck Fractures / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005272:Femur Neck / Q000503:physiopathology / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007085:Ilium / Q000637:transplantation; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D012086:Reoperation; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
keywords: Femur; Fixation; Neck; Non-union; Osteotomy; Triple; Valgus