Abstract
Revision internal fixation for femoral neck nonunion in young patients can pose a surgical challenge. Hip salvage protocols include osteotomy and osteosynthesis using various implants and grafting techniques (muscle pedicle, vascularised or nonvascularised fibular graft). The purpose of this study was to evaluate the clinical outcomes of vascularised iliac grafting for femoral neck nonunion in patients younger than 50 years. A total of 22 patients underwent vascularised iliac grafting and internal fixations for femoral neck nonunion were retrospectively analysed. Their mean age was 36.6 years. The cases were evaluated radiographically and clinically. All the patients were followed-up for an average of 64.6 months. The mean time to union for all patients was 5.4 months. The mean Harris Hip Score had increased from 55.3 preoperatively to 85.2 at the latest follow-up. The average neck-shaft angle had changed from 127.4° preoperatively to 128.3° postoperatively. Postoperative progression of osteonecrosis of the femoral head was seen in 3 patients, 2 patients were pain free and 1 patient required total hip arthroplasty 9 years after the revision procedure. There was no further progression in 3 patients with preoperative radiological evidence of the femoral head osteonecrosis. This study indicates that vascularised iliac grafting is a viable option in treatment of femoral neck nonunion in the young adult.
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