Nonunion in Pediatric Femoral Neck Fractures.

Abstract

➢ Nonunion is the third most common complication of femoral neck fractures in children after osteonecrosis and premature physeal closure causing coxa vara.➢ The most common cause of nonunion of a femoral neck fracture in developed countries is failure of fixation or loss of reduction, whereas in developing countries, it is delayed presentation.➢ Most failures of fixation, if identified in time (<3 months), retain adequate bone contact. Hence, removal of the offending implant, refixation without bone-grafting, and valgus osteotomy to correct the biomechanical forces by converting the vertical fracture line into a horizontal fracture line provide adequate results with respect to osseous union.➢ In patients with a delayed presentation, the intervening fibrous tissue and resorption of the neck pose challenges. In these patients, in addition to performing a valgus osteotomy and fixation, in situ stabilization across the fibrous tissue and reconstruction of the inferomedial aspect of the neck using fibular strut-grafting, which adds stability, bone contact, and biological material, provide adequate union.