Neck Reconstruction (Aiims Box Technique) in the Management of Large Femoral Neck Defects

Abstract

Large femoral neck defects are frequently associated with neglected femoral neck fractures, sequelae of infection, and failed fixation devices. The AIIMS box technique of neck reconstruction has the objectives of femoral head preservation and restoration of hip function in such cases. 32 patients (age range 20-56, average 38 years) with large femoral neck defects were treated from January 1990 to May 1997 and were followed up for a minimum of 10 years (range 10 to 17 years). The neck defect was converted into a box using osteal flaps (base from greater trochanter, anterior wall from head, quadratus femoris muscle pedicle graft posteriorly), which was filled with cancellous bone autograft, and stabilized with cancellous screws. Union occurred in all patients in a mean time of 16 weeks (range 12-20 weeks). One patient developed avascular necrosis (AVN) of femoral head. 8 out of 32 results were classified as excellent, 22 good and 2 fair. Good functional mobility was seen in all but two patients. Complications included coxa vara in two patients, and fixation problems in four patients. Large femoral neck defects can be managed successfully by this technique with preservation of the viability of the femoral head, and therefore the procedure should be considered in appropriate cases, particularly in young adults.