title: Salvage of failed osteosynthesis of an intracapsular fracture of the femoral neck using two cannulated compression screws and a vascularised iliac crest bone graft.
abstract: We evaluated the outcome of treatment of nonunion of an intracapsular fracture of the femoral neck in young patients using two cannulated screws and a vascularised bone graft. A total of 32 patients (15 women and 17 men, with a mean age of 36.5 years; 20 to 50) with failed internal fixation of an intracapsular fracture were included in the study. Following removal of the primary fixation, two cannulated compression screws were inserted with a vascularised iliac crest bone graft based on the ascending branch of the lateral femoral circumflex artery. At a mean follow-up of 6.8 years (4 to 10), union was achieved in 27 hips (84%). A total of five patients with a mean age of 40.5 years (35 to 50) had a persistent nonunion and underwent total hip arthroplasty as also did two patients whose fracture united but who developed osteonecrosis of the femoral head two years post-operatively. Statistical analysis showed that younger patients achieved earlier and more reliable union (p < 0.001). The functional outcome, as assessed by the Harris Hip score, was better in patients aged < 45 years compared with those aged > 45 years (p < 0.001). These findings suggest that further fixation using two cannulated compression screws and a vascularised iliac crest bone graft is an effective salvage treatment in patients aged < 45 years, in whom osteosynthesis of a displaced intracapsular fractures of the femoral neck has failed.
authors.affiliation: Zhongshan Hospital of Dalian University, Dalian, 116001, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Xiaobing
authors.affiliation: Zhongshan Hospital of Dalian University, Dalian, 116001, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Dewei
mesh_terms: D000328:Adult; D001863:Bone Screws; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D016879:Salvage Therapy; D017211:Treatment Failure; D055815:Young Adult
keywords: Avascular necrosis of femoral head; Femoral neck fracture; Internal fixation; Nonunion