Long Term Results of Fresh Femoral Neck Fractures Treated by Cancellous Screw and Fibular Autograft

Abstract

Femoral neck fractures in adults have a poor prognosis because of high incidence of non-union and aseptic necrosis. Prosthetic replacement of the femoral head is reserved for the physiologically older patients while osteosynthesis with preservation of femoral head is the treatment of choice for fracture neck femur in younger adults. Various types of bone graft supplementation have been advocated to reduce the incidence of nonunion and avascular necrosis. We tried cancellous screw fixation supplemented by fibular autologous grafting to overcome nonunion and avascular necrosis. Thirty-five (M-18: F-17) skeletally mature patients (mean age 49.38 years) of fresh femoral neck fracture were treated. Weight bearing was allowed only after 3 months, or later if the radiological signs of union was not seen. All fractures showed union at one year follow up. Complications included, avascular necrosis (2 cases), broken fibular graft (3 cases), screw back out with collapse (2 cases), penetration of the femoral head articular surface by screw and graft (1 case each). Patients are able to sit cross-legged and squatting position. Cancellous screw fixation and fibular autologous grafting is a safe, cost effective and reliable surgical technique for treating femoral neck fractures in properly selected patients.