Abstract
Purpose
Revision internal fixation for femoral-neck nonunion is a challenging procedure. Treatment options are osteotomy, osteosynthesis using various implants and grafting techniques (muscle pedicle, vascularised or nonvascularised fibular graft) or arthroplasty. The objective of this article is to report the outcome of revision internal fixation using an angle blade plate and autogenous fibular graft in symptomatic aseptic femoral-neck nonunion.
Methods
Twenty-two patients who had been treated previously with cannulated screws or dynamic hip screw for femoral-neck fracture and progressed to nonunion were treated with revision internal fixation using an angle blade plate and autogenous nonvascularised fibular graft. Mean patient age was 38 (range 21–52) years, with average duration between injury and revision surgery 11.2m (range 8–16 months).
Results
Other than one nonunion, we achieved union in all patients (21 patients, 91%) after an average period of 4.4 months. The functional outcome after 3.2 years as per scoring system given by Nagi et al.. showed excellent results in four, good in ten, fair in six and poor in two patients. Patients with poor results included one with nonunion and other with avascular necrosis with collapse of the femoral head. Average limb shortening was 1.5 cm, and mean femoral-neck-shaft angle was 116°. There was no instance of fibular graft fracture, slippage or implant cut-through.
Conclusion
Angle blade plate provides rigid stability and offloads any shearing force over the fibular graft when used for revision internal fixation in aseptic femoral-neck nonunion. Thus, the fibular graft only serves the purpose of osteogenesis and stimulates the surrounding host cells to promote healing at the nonunion site. We recommend the angle blade plate and autogenous fibular graft as a viable option for hip-joint salvage in revision internal fixation of aseptic femoral-neck nonunion.
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References
Lu-Yao GL, Keller RB, Littenberg B, Wennberg JE (1994) Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. J Bone Joint Surg Am 76:15–25
Davidovitch RI, Jordan CJ, Egol KA, Vrahas MS (2010) Challenges in the treatment of femoral neck fractures in the nonelderly adult. J Trauma 68:236–242
Mathews V, Cabanela ME (2004) Femoral neck nonunion treatment. Clin Orthop Relat Res 419:57–64
Nagi ON, Dhillon MS, Goni VG (1998) Open reduction, internal fixation and fibular autografting for neglected fracture of the femoral neck. J Bone Joint Surg Br 80:798–804
Elgafy H, Ebraheim NA, Bach HG (2011) Revision internal fixation and nonvascular fibular graft for femoral neck nonunion. J Trauma 70:169–173
Jun X, Chang-Qing Z, Kai-Gang Z, Hong-Shuai L, Jia-Gen S (2010) Modified free vascularized fibular grafting for the treatment of femoral neck nonunion. J Orthop Trauma 24:230–235
Azam MQ, Iraqi A, Sherwani M, Sabir AB, Abbas M, Asif N (2009) Free fibular strut graft in neglected femoral neck fractures in adult. Indian J Orthop 43(1):62–66
Angelini M, McKee MD, Waddell JP, Haidukewych G, Schemitsch EH (2009) Salvage of failed hip fracture fixation. J Orthop Trauma 23(6):471–478
Haidukewych GJ (2009) Salvage of failed treatment of femoral neck fractures. Instr Course Lect 58:83–90
Jackson M, Learmonth ID (2002) The treatment of nonunion after intracapsular fracture of the proximal femur. Clin Orthop Relat Res 399:119–128
Chua D, Jaglal SB, Schatzker J (1998) Predictors of early failure of fixation in the treatment of displaced subcapital hip fractures. J Orthop Trauma 12:230–234
Raaymakers EL, Marti RK (2008) Nonunion of the femoral neck: possibilities and limitations of the various treatment modalities. Indian J Orthop 42(1):13–21
Ballmer FT, Ballmer PM, Baumgaertel F, Ganz R, Mast JW (1990) Pauwels osteotomy for nonunions of the femoral neck. Orthop Clin North Am 21:759–767
Said GZ, Farouk O, Said HG (2010) Valgus intertrochanteric osteotomy with single-angled 130° plate fixation for fractures and non-unions of the femoral neck. Int Orthop 34(8):1291–1295
Wu CC, Shih CH, Chen WJ, Tai CL (1999) Treatment of femoral neck nonunions with a sliding compression screw: Comparison with and without subtrochanteric valgus osteotomy. J Trauma 46:312–317
Min BW, Bae KC, Kang CH, Song KS, Kim SY, Won YY (2006) Valgus intertrochanteric osteotomy for non-union of femoral neck fracture. Injury 37:786–790
Liporace F, Gaines R, Collinge C, Haidukewych GJ (2008) Results of internal fixation of Pauwels type-3 vertical femoral neck fractures. J Bone Joint Surg Am 90(8):1654–1659
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Sen, R.K., Tripathy, S.K., Goyal, T. et al. Osteosynthesis of femoral-neck nonunion with angle blade plate and autogenous fibular graft. International Orthopaedics (SICOT) 36, 827–832 (2012). https://doi.org/10.1007/s00264-011-1344-1
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DOI: https://doi.org/10.1007/s00264-011-1344-1