Reconstruction of blood supply to the femoral head and neck with a partial gluteus medius-ilium flap in young and middle-aged patients

Abstract

Objective To study the therapeutic effect of partial gluteus medius-ilium flap in reconstruction of the blood supply to the femoral head and neck to treat femoral neck fracture and femoral head necrosis in young and middle-aged adults. Methods From June 2004 to December 2009, we treated 20 patients with femoral neck fracture and femoral head necrosis. They were 15 men and 5 women, aged from 25 to 56 years (mean, 38. 6 years). In the 10 cases of femoral neck fracture (group A), there were 7 men and 3 women, and 2 Garden type Ⅱ, 5 type Ⅲ and 3 type Ⅳ fractures. The duration from injury to surgery averaged 14. 3 days (from 11 to 23 days). In the 10 cases of femoral head necrosis (group B), there were 8 men and 2 women, and 6 ones of Ficat phase Ⅱ and 4 ones of phase Ⅲ. Group A were treated with reduction and hollow nail fixation. Group B were treated with removal of the necrotic bone and graft of iliac spongy bone.Partial gluteus medius-ilium flaps were used in both groups to reconstruct the blood supply to the femoral head and neck. Results The 20 patients were followed up for one to 5 years (mean, 3. 1 years). In group A,all fractures healed and the average Harris hip score 3 months postoperation was 92 (range, 81 to 97) .Femoral head necrosis occurred in one case. In group B, the symptoms were greatly improved and the average Harris hip score 3 months postoperation was 84 (range, 73 to 95). Deterioration was found in 3 cases, 2 of which had to sustain hip replacement. Conclusion The partial gluteus medius-ilium flap is effective in reconstruction of the blood supply to the femoral head and neck, because it keeps abundant blood supply, and is simple, safe and reliable to handle without sacrificing function of the gluteus medius. Key words: Femur head necrosis; Femoral neck fractures; Transplants; Blood supply reconstruction