The use of quadratus femoris muscle pedicle bone graft for the treatment of displaced femoral neck fractures.

Abstract

In 1974, Meyers et al advocated the use of the quadratus femoris muscle pedicle bone graft with screw fixation to treat displaced femoral neck fractures. In 1979 he quoted a 95% union rate in 144 patients and a 5% incidence of late segmental collapse. Most authors quote a 60% to 80% union rate and a 25% to 30% incidence of late segmental collapse of the femoral head. From 1974 to 1980 at the University of Rochester, there were 13 patients, ages 20 to 60 years, who underwent the Meyers procedure for displaced femoral neck fractures. Twelve patients were done acutely and one was delayed. Followup averaged 38 months. Average time to bony union was five months. One patient had a nonunion secondary to inadequate fixation. Four patients showed radiographic evidence of late segmental collapse despite fracture union. These patients were between 20 and 28 years old. They had moderate to severe symptoms including pain, limitation of motion, and a limp. Subsequently two of them had total hip replacements and one a valgus osteotomy. To date few if any reports have reaffirmed the results obtained by Meyers et al. Although our series is small, the rate of union was 85% and the rate of late segmental collapse was 23%. These results are the same as or worse than those achieved by several authors using internal fixation alone or in combination with autogenous bone graft.