Fixation with Cancellous Screws and Fibular Strut Grafts for Neglected Femoral Neck Fractures
Purpose. 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 clos...
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2014-08-01
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Series: | Journal of Orthopaedic Surgery |
Online Access: | https://doi.org/10.1177/230949901402200213 |
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doaj-ac6ea96193584ccabd80934cb640f4f62020-11-25T03:20:53ZengSAGE PublishingJournal of Orthopaedic Surgery2309-49902014-08-012210.1177/230949901402200213Fixation with Cancellous Screws and Fibular Strut Grafts for Neglected Femoral Neck FracturesChandra Prakash Pal0Binod Kumar1Karuna Shankar Dinkar2Pulkesh Singh3Harish Kumar4RK Goyal5 Department of Orthopaedics, SN Medical College, Agra, India Varanasi, India Department of Orthopaedics, SN Medical College, Agra, India Department of Orthopaedics, UPRIMS & R, Saifai, India Department of Orthopaedics, Safdarjung Hospital, New Delhi, India Department of Orthopaedics, UPRIMS & R, Saifai, IndiaPurpose. 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. Conclusion. 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.https://doi.org/10.1177/230949901402200213 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Chandra Prakash Pal Binod Kumar Karuna Shankar Dinkar Pulkesh Singh Harish Kumar RK Goyal |
spellingShingle |
Chandra Prakash Pal Binod Kumar Karuna Shankar Dinkar Pulkesh Singh Harish Kumar RK Goyal Fixation with Cancellous Screws and Fibular Strut Grafts for Neglected Femoral Neck Fractures Journal of Orthopaedic Surgery |
author_facet |
Chandra Prakash Pal Binod Kumar Karuna Shankar Dinkar Pulkesh Singh Harish Kumar RK Goyal |
author_sort |
Chandra Prakash Pal |
title |
Fixation with Cancellous Screws and Fibular Strut Grafts for Neglected Femoral Neck Fractures |
title_short |
Fixation with Cancellous Screws and Fibular Strut Grafts for Neglected Femoral Neck Fractures |
title_full |
Fixation with Cancellous Screws and Fibular Strut Grafts for Neglected Femoral Neck Fractures |
title_fullStr |
Fixation with Cancellous Screws and Fibular Strut Grafts for Neglected Femoral Neck Fractures |
title_full_unstemmed |
Fixation with Cancellous Screws and Fibular Strut Grafts for Neglected Femoral Neck Fractures |
title_sort |
fixation with cancellous screws and fibular strut grafts for neglected femoral neck fractures |
publisher |
SAGE Publishing |
series |
Journal of Orthopaedic Surgery |
issn |
2309-4990 |
publishDate |
2014-08-01 |
description |
Purpose. 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. Conclusion. 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. |
url |
https://doi.org/10.1177/230949901402200213 |
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