Abstract
ObjectiveThis study aimed to evaluate the preliminary clinical and radiographic outcomes of acute displaced femoral neck fracture treated by closed reduction and internal fixation (CRIF) with free iliac bone block grafting with comparison to a routine protocol of CRIF without bone grafting.MethodsFrom December 2008 to February 2010, 220 adult patients with acute displaced femoral neck fractures were enrolled in this study. In study group, there were 124 patients (57 males, 67 females) with a mean age of 44.8 years (range, 20-64 years). There were 70 transcervical fractures and 54 subcapital fractures. The patients were treated by CRIF and free iliac bone block grafting. The control group consisted of 96 adult patients (46 males, 50 females) with a mean age of 46.3 years (range, 23-64 years). There were 61 transcervical fractures and 35 subcapital fractures. The patients in control group were treated by CRIF without bone grafting.ResultsIn study group, 112 patients were followed up for an average of 27.4 months (range, 24-34 months). All fractures healed within 5 months. However, 10 patients presented AVN of the femoral heads. The mean Harris score was 88.6 (range, 41-100). In control group, 68 patients were followed up for an average of 31.2 months (range, 24-42 months). The rates of AVN of the femoral head and fracture nonunion in control group were 26.5% (18/68) and 16.2% (11/68), respectively, significantly higher than those in study group (both P<0.05). The mean Harris score in control group was 83.8 (41–100), significantly lower than that in study group (P<0.05).ConclusionAcute displaced femoral neck fractures can be treated by CRIF and free iliac bone block grafting in a minimally invasive manner. This technique can guarantee uneventful fracture healing and significantly reduce the rate of femoral head osteonecrosis.
Highlights
Femoral neck fractures are frequently complicated by avascular necrosis (AVN) of the femoral head and fracture nonunion [1]
To pursue an outcome with less invasion and better functional rehabilitation, we established a protocol of closed reduction and internal fixation (CRIF) with three cannulated screws for acute femoral neck fractures, which was supplemented with non-vascularized iliac bone block graft
This study investigated the outcomes of acute displaced femoral neck fractures treated by CRIF augmented with free iliac bone block autografts with comparison to a routine protocol of CRIF without bone grafting
Summary
Femoral neck fractures are frequently complicated by avascular necrosis (AVN) of the femoral head and fracture nonunion [1]. The risk of AVN has been reported to be as high as 10% to 43% [2,3,4,5,6,7,8,9,10]. The risk for non-union is greater with displaced fractures and has been reported to be as high as 30% in some series [5,8,15]. A variety of bone grafting procedures have been described to address the problem of nonunion and AVN of the femoral head, including nonvascularized bone grafting, muscle–pedicle bone grafting, vascularized bone grafting, and osteotomy [1,16,17,18,19]. This study aimed to evaluate the preliminary clinical and radiographic findings of displaced femoral neck fractures treated following this protocol
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