Nonunion Of Femoral Neck Fracture Research Articles

Editorial Comment on the Article by A.O. Farion et al.
 “Migration of a Kirschner Wire Into the Urinary Bladder: A Case Report”

The article Migration of a Kirschner Wire into the Bladder: Case Report describes a rather rare but serious complication after osteosynthesis of a medial femoral neck fracture performed with wires, that is a fatigue fracture of a Kirschner wire with migration of its proximal fragment into the bladder. It is stated in the commentary that such complications do occur and the results of their successful treatment have been published in the modern scientific literature. The author of the commentary draws attention to the tactical and organizational aspects of treating patients with femoral neck fractures related to this case. It is pointed out that there are standard replicable osteosynthesis techniques for fractures of a number of localizations that provide good clinical results. Proximal femur is one of these localizations, and the methods of surgical treatment of its fractures are described in details in current clinical guidelines. Possible reasons for the long-term persistence of pseudarthrosis of the femoral neck are also analyzed. Conclusions: when choosing a method of surgical treatment, it is necessary to follow the approved clinical guidelines to reduce the risks of nonunion of femoral neck fractures. Hip arthroplasty should be performed without delay in cases of fracture nonunion after osteosynthesis.

Application of 3-dimensional printing technology in the treatment of postoperative nonunion of femoral neck fracture: A case report.

Nonunion of the femoral neck represents the main complication following fractures at this location. Few studies have documented the application of 3-dimensional printing technology for the surgical treatment of postoperative nonunion of femoral neck fractures. The present manuscript describes a case of a particular 3-dimensional printing technology method for designing a custom-made guide plate for revision surgery. A 46-year-old man suffered a nonunion of the femoral neck following an internal fracture fixation. Using 3-dimensional printing technology, we preoperatively printed a femur model and a custom-made guide plate. Using the model, we performed a simulated operation before the surgery, and the guide plate was used for accurate osteotomy during the operation. With this method, we achieved the desired results: the fracture healed, the operation time was shortened, and there was no femoral head necrosis. Our case suggests that 3-dimensional printing technology provides an effective aid in the treatment of patients with nonunion following a femoral neck fracture and recommends 3-dimensional printing technology for such cases.

Treatment of Chronic Femoral Neck Fracture With Cemented Bipolar Hemiarthroplasty and Management of Intraoperative Fracture With Cerclage Cabling.

We cover the operative treatment of a neglected chronic femoral neck fracture nonunion treated at 6 months. We begin with a description of the case and concomitant injuries. The operative portion includes the direct lateral approach with the patient in lateral decubitus position, exposure of the fracture site, osteotomy of the neck, debridement of the nonunion site, broaching, trialing, recognition and treatment of an intraoperative proximal femur fracture using cerclage cabling above and below the lesser trochanter, cementation of final components, and reduction. We conclude with the patient's radiographs at 2 weeks and clinical outcome at 6-week follow-up.

Ложные суставы шейки бедренной кости: применение новой классификации при эндопротезировании у пациентов пожилого возраста

Introduction The risk of the femoral neck fracture nonunion is 48 % with avascular necrosis of the femoral head being reported in 42 % of cases. There are many classifications of acute intra-articular fractures of the proximal femur and there are no grading systems for femoral neck nonunions that would allow prediction of outcomes of total hip arthroplasty (THA). The objective was to evaluate mid-term results of THA in patients with femoral neck nonunion and develop a new classification of nonunions. Material and methods A prospective cohort single-center comparative study included 78 elderly patients with atrophic femoral neck nonunions treated with primary THA. The mean follow-up period was 24.2 months. Three prospective groups were identified. Separation criteria included shortening of the lower limb and femoral offset, changes in the Barnett-Nordin index, the Hounsfield bone density index, the presence of metal constructs and bone defects. Groups A and B were divided into 2 subgroups depending on the presence/absence of fixation metal constructs for a femoral neck fracture. Group C was divided into 2 subgroups: type C1, acetabular defect and type C2, proximal femur defect. Results Mean operating time was 81.1 minutes in group A, 102.9 minutes in group B and 145.2 minutes in group C. The minimum blood loss was recorded in group A measuring on average 429.25 mL in both subgroups. The maximum blood loss was seen in patients of groups B and C measuring 606.62 mL and 631.5 mL. Overall revision rate was 7.7 %. Conclusion A classification for femoral neck nonunions was developed suggesting grading patients into 3 types: type A, type B and type C which were further divided into 2 subtypes. The grading system was based on lower limb shortening and femoral offset, severity of osteoporosis, presence of metal constructs and acetabulum or proximal femur bone defect which prognostically affected the outcome of THA.

Intertrochanteric valgus osteotomy for post-traumatic coxa vara after proximal femur fractures: A retrospective study.

To investigate the clinical effects of a new intertrochanteric valgus osteotomy technique designed by the authors for treatment of post-traumatic coxa varus after proximal femur fractures. Retrospectively analyzed 11 patients who developed coxa vara after sustaining proximal femoral fractures were treated with intertrochanteric valgus osteotomy from December 2005 to December 2018 in our hospital. This study included 6 cases of intertrochanteric fracture deformity union, 3 cases of subtrochanteric fracture nonunion and 2 cases of femoral neck fracture nonunion. Measured the degree of coxa varus, the differences in the lower limb length and force line in all patients. Evaluated hip function with the Harris hip score. All injuries were treated with the authors’ intertrochanteric valgus osteotomy technique. The average follow-up period was 3 years and evaluated the clinical effects by radiological examination and the Harris hip score. The average neck–shaft angle increased 35.0° (99.1°–134.1°) and the average limb shortening lengthened 1.9 cm (2.9–1.0 cm) after surgery. The average operating time was 67.2 minutes and blood loss was 237.7 ml. The osteotomy position healed in all patients 3 months later. Union of the 2 old femoral neck fractures was achieved 4 and 6 months after surgery, respectively, and no femoral head necrosis occurred during follow-up. The Harris hip score increased an average of 49 points (44.1–93.1 points) at 1 year postoperatively. Our self-designed intertrochanteric valgus osteotomy technique showed a favorable clinical effect to treatment coxa vara and can be used in the clinical setting.

Effectiveness of triangular stabilization system for patients with postoperative nonunion of femoral neck fracture

To explore the effectiveness of triangular stabilization system in the treatment of postoperative nonunion of femoral neck fracture. The clinical data of 30 patients with postoperative nonunion of femoral neck fracture who met the selection criteria between December 2014 and December 2019 were retrospectively analyzed. There were 21 males and 9 females with an average age of 40.7 years (range, 15-65 years). The Pauwels angle at the time of injury was 51°-79°, with an average of 63.6°. According to the Pauwels classification, they were all type Ⅲ. The time from the first operation to this revision operation was 5-24 months, with an average of 9.7 months. The preoperative visual analogue scale (VAS) score was 4.2±1.3, the Harris score was 31.2±5.3, the neck-shaft angle was (116.3±7.9)°, and the lower limb shortening length was (1.73±0.53) cm. Triangular stabilization system, which was made of dynamic condylar screw and medial anatomical buttress plate, combined with the window bone grafting at the fracture site was used for bone nonunion revision. The postoperative lower limb shortening length, neck-shaft angle, fracture healing time, and complications were recorded; the Harris score was used to evaluate the hip joint function, and the VAS score was used to evaluate the pain improvement before and after operation. All patients were followed up 12-60 months, with an average of 27.7 months. There was no clear sign of femoral head necrosis and collapse after operation; 1 patient developed infection at 4 months after operation, and the incision healed after debridement and removal of internal fixator. All patients achieved bone healing, and the healing time was 2.8-6.0 months, with an average of 3.9 months. At last follow-up, the lower limb shortening length was (0.30±0.53) cm, which was significantly corrected when compared with preoperative one ( t=16.721, P=0.000); the neck-shaft angle was (133.9±5.7)°, which was significantly recovered when compared with preoperative one ( t=-11.239, P=0.000). The VAS score was 0.7±0.9, the Harris score was 88.3±5.9, both of which were significantly improved when compared with preoperative scores ( t=16.705, P=0.000; t=-40.138, P=0.000). Triangular stabilization system combined with window bone grafting can provide a stable and balanced mechanical environment, promote fracture healing, and achieve satisfactory effectiveness in the treatment of postoperative nonunion of femoral neck fracture.

Valgus Osteotomy Outcome for Treating Femoral Neck Nonunion in Young and Active Patients

Background: Femoral neck fracture nonunion is a frequent and challenging complication, with several surgical options. Objectives: The present study reported the outcome of valgus osteotomy for treating femoral neck nonunion in patients aged <65 years. Methods: This case series research included young patients who underwent valgus osteotomy for treating femoral neck nonunion or device failure of the index surgery. The fixation of the osteotomy site was performed using either a dynamic hip screw or a fixed angle blade. The union of the neck and osteotomy site (subtrochanteric region) was evaluated by monitoring callus formation in the postoperative radiographs. Limb length discrepancy, Pauwels’ angle, and the neck-shaft angle were evaluated before the surgery and at the last follow-up. Postoperative complications were extracted from the explored patients’ profiles. Results: Twenty patients with a Mean±SD age of 27.2±10.8 years were examined in this study‎. The Mean±SD follow-up time of the patients was 6.1±3.9 years. The femoral neck was united in 18 patients in a Mean±SD period of 5.1±2.3 months. The Mean±SD limb length discrepancy was measured as 1.3±0.8 cm before and 0.5±0.7 cm after the ‏osteotomy. The Mean±SD Pauwels’ angle was calculated as 65.5±16.9º before and 32.4±16.2º after the osteotomy. The Mean±SD neck-shaft angle was computed to be 121.9±22.8º before and 144.5±17.7º after the osteotomy. Revision surgery was performed for 6 (30%) patients. This measure included device removal in 4 and total hip arthroplasty in 2 patient. Conclusion: Valgus osteotomy is a safe and efficient technique for managing femoral neck nonunion. Therefore‎, this approach is suggested as a good alternative for total hip arthroplasty, particularly in young and active patients‎.

Should Nonunion Femoral Neck Fractures in Children be Treated with Extracorporeal Shockwave Therapy Under Navigation Guidance?

PurposeTo present the accuracy and safety of treat nonunion of children femoral neck fracture using the technique with extracorporeal shockwave therapy (ESWT) under navigation guidance. MethodsWe retrospectively reviewed 3 consecutive children patients. A total of 3 nonunion of femoral neck fracture in 3 patients had been used the technique with extracorporeal shockwave therapy under navigation guidance. We also assessed the clinical and radiological outcomes and analyzed the union degree of femoral neck fracture on the postoperative X ray. ResultsRadiological and clinical outcomes of three patients are satisfactory and achieve the recovery standard. There was no neurovascular (femoral nerve, femoral vein, femoral artery) complication related with ESWT under navigation guidance. ConclusionThis technique (extracorporeal shockwave therapy under navigation guidance) could be considered relatively safe and easy method to treat nonunion of femoral neck fracture of children.

Treatment of femoral neck nonunion with a new fixation construct through the Watson-Jones approach

ObjectiveThe aim of the study is to explore the clinical effect of a dynamic condylar screw (DCS) system, medial anatomical buttress plate (MABP), and autogenous iliac bone graft through the Watson-Jones approach in the treatment of femoral neck nonunion. MethodsThis prospective study included 15 patients (12 men and 3 women) with nonunion of femoral neck fracture, who were treated with the DCS and MABP with autogenous iliac bone graft through the Watson-Jones approach. The patients were followed up for an average of 16 months (range, 12–24 months). ResultsAll patients achieved bone healing with an average fracture healing time of 3.4 months (2.8–4.6 months). The Harris score significantly increased from 30 ± 3.9 before the operation to 87.6 ± 7.9 at the last follow-up, and the visual analogue scale significantly decreased from 4 ± 1.3 before the operation to 1 ± 1.7 at the last follow-up. The average limb shortening was reduced from 1.8 cm (range, 0–3.1 cm) before the revision operation to 0.5 cm (range, 0.1–1.3 cm) after the last follow-up. The neck-shaft angle of the injured side was restored from an average of 118° (range, 108–139°) before the revision operation to an average of 132° (range, 127–144°) at the last follow-up. No collapse of the femoral head, wound infections, screw backout, screw or plate breakages, or nerve injury was found. ConclusionTheDCS and MABP with autogenous iliac bone graft through the Watson-Jones approach is an effective option for the treatment of femoral neck nonunion or delayed healing. The translational potential of the articleThis article shows that the application of DCS and MABP provides a rigid fixation at the fracture site to promote bone graft integration and bone union. This new kind of technique could be one option of Hip conservation procedures, just special for young patients with femoral neck nonunion.

Околонедельные колебания проекционной минеральной плотности в зонах Груена после тотальной артропластики тазобедренного сустава (случай из практики и краткий обзор литературы)

Introduction Dual-energy X-ray absorptiometry (DEXA) provides a quantitative estimation of the projectional bone mineral density (PBMD) with minor radiation exposure and in a cost-effective way. It is one of the ways for a dynamic control of stem integration into the host bone after total hip arthroplasty (THA). Osteocytes are considered to play the key role in the regulation of implant integration process. Hence, DEXA could be used for estimation of functional activity and directions for regulation of osteocytes activities in the periprosthetic area. Purpose Current study presents the results of chronologic and biological PBMD in the periprosthetic zone after THA in two patients with a perspective for a future use of such an approach to reveal a local response of tissue to the implant. Material and methods PBMD was studied daily for 10 days with PRODIGY densitometer after THA in a 54-year old patient with posttraumatic right hip osteoarthrosis and a 59-year old patient with right femoral neck fracture nonunion. Cementless ZIMMER implants were used. Results In the first patient, oscillatory BMD alterations in the Gruen zones ranged from 2.4 to 11.6 % with an average wavelength of 4.6 days. In the second patient, the alterations were within the range of 2.3–8.7 % with an average wavelength of 4.5 days. PBMD changes in the adjacent Gruen zones occurred asymmetrically with some oscillational phase lagging relative to each other. After approximation of the results by linear trend, PBMD increased by 1.7 % on average in all Gruen zones in the first patient, except zones 2 and 3, and its mean growth was 1.7 %. On the contrary, PBMD decreased in all the zones in the second patient, except zones 4 and 7. Mean decrease was 1.7 %. Conclusion Chronobiological approach opens up possibilities for evaluation of structural and functional skeleton reorganization in the periprosthetic zone after THA. Further research is needed for a deeper insight into this complex issue.

Recent Concept for Management of Femoral Neck Fracture Non-Union in Young Adults

Recent Concept for Management of Femoral Neck Fracture Non-Union in Young Adults

Fibular strut graft for nonunited femoral neck fractures in children.

PurposeTo evaluate the clinical and radiological outcomes of using fibular strut grafts as a fixation device for non-united femoral neck fractures in children with or without subtrochanteric valgus osteotomy.MethodsA total of 12 children with non-united femoral neck fractures (nine males and three females) with an average age of 8.2 years (5 to 12) were managed, and functional results evaluated, between July 2013 and July 2015. The mechanisms of injury were fall from a height in ten patients and road traffic accident in two cases. Nine cases of femoral neck nonunion followed failed internal fixation and three cases were neglected fractures. Six cases were treated by fibular strut graft and subtrochanteric valgus osteotomy with contoured plate and six cases were treated by fibular strut graft and hip spica.ResultsThe mean follow-up period was 20.4 months (12 to 36). Union was achieved in all 12 cases by a mean of 3.5 months (2.5 to 6). All patients were satisfied at five months. For final analysis of clinical and radiographic results, the Ratliff’s classification was used. We classed 11 cases as good results and one case as fair.ConclusionsFibular strut grafts are a reliable option for treatment of pseudo-arthrosis in femoral neck fracture nonunion in children. It is successful in restoration of femoral neck length in children with non-united femoral neck fractures.

Nonvascularized fibular grafting in nonunion of femoral neck fracture: A systematic review.

Nonunion of femoral neck fractures following primary fixation and neglected femoral neck fracture in young adults is a challenging task. Every effort should be directed toward hip joint salvage in these patients. Among different available options of hip salvage, nonvascularized fibular graft (NVFG) osteosynthesis is simple, easy to perform, and a successful technique. In this review, the available literature on NVFG in neglected and nonunion femoral neck fractures has been analyzed. After review of 15 articles on NVFG, the average nonunion rate was estimated to be 7.86% (range 0–31%). Six articles that evaluated the preoperative and postoperative osteonecrosis reported improvement in 50% patients. The clinical and/or functional outcome was good to excellent in 56–96% patients following fibular osteosynthesis. Few complications such as coxa vara deformity, limb shortening, and intraarticular penetration of the graft or hardware have been reported. However, there are minimal donor site morbidities such as mild ankle pain, transient loss of toe flexors and extensors and transient lateral popliteal nerve palsy.

The Radiographic Union Score for Hip (RUSH) Identifies Radiographic Nonunion of Femoral Neck Fractures

The Radiographic Union Score for Hip (RUSH) is a previously validated outcome instrument designed to improve intra- and interobserver reliability when describing the radiographic healing of femoral neck fractures. The ability to identify fractures that have not healed is important for defining nonunion in clinical trials and predicting patients who will likely require additional surgery to promote fracture healing. We sought to investigate the utility of the RUSH score to define femoral neck fracture nonunion. (1) What RUSH score threshold yields at least 98% specificity to diagnose nonunion at 6 months postinjury? (2) Using the threshold identified, are patients below this threshold at greater risk of reoperation for nonunion and for other indications? A representative sample of 250 out of a cohort of 725 patients with adequate 6-month hip radiographs was analyzed from a multinational elderly hip fracture trial (FAITH). All patients had a femoral neck fracture and were treated with either multiple cancellous screws or a sliding hip screw. Two reviewers independently determined the RUSH score based on the 6-month postinjury radiographs and interrater reliability was assessed with the interclass correlation coefficient (ICC). There was substantial reliability between the reviewers assigning the RUSH scores (ICC, 0.81; 95% confidence interval [CI], 0.76-0.85). The RUSH score is a checklist-based system that quantifies four measures of healing: cortical bridging, cortical fracture disappearance, trabecular consolidation, and trabecular fracture disappearance.. Fracture healing was determined by two independent methods: (1) concurrently by the treating surgeon using both clinical and radiographic assessments as per routine clinical care; and (2) retrospectively by a Central Adjudication Committee using complete obliteration of the fracture line on radiographs alone. Receiver operating characteristic tables were used to define a RUSH threshold score that was > 98% specific for fracture nonunion. A threshold score of < 18 was associated with a 100% specificity (95% CI, 97%-100%) and a positive predictive value of 100% (95% CI, 73%-100%) for radiographic nonunion. In contrast, using the fracture healing assessments of the treating surgeons failed to identify a useful discriminatory nonunion threshold and the highest positive predictive value was 43%. With respect to complications, patients with RUSH scores below 18 had greater risk of undergoing reoperation for nonunion (reoperation when < 18: six of 13 [46%]; reoperation when ≥ 18: 11 of 237 [54%]; relative risk [RR], 9.9 [95% CI, 4.4-22.7]; p < 0.001) and for all indications (reoperation when < 18: eight of 13 [62%]; reoperation when ≥ 18: 54 of 237 [38%]; RR, 2.7 [95% CI, 1.7-4.4]; p = 0.004). The 6-month RUSH score is a reliable method for assessing radiographic healing. Our results highlight the discordance between radiographic determinations and clinician assessments of fracture healing and stress the need for clinical data to be incorporated in research studies evaluating fracture healing. Level III, diagnostic study.

Triple attack technique for non-union of femoral neck fractures.

The purpose of this study was to describe the technique and clinical results following the utilization of biomechanical and biological means for adequate fracture healing in management of non-union of the neck of femur while preventing distortion of normal hip biomechanics. Twenty-two patients with non-united fractures of femoral neck in adults were treated with what was termed the 'triple attack' procedure. This constituted iliac autogenous bone grafting, valgus subtrochanteric osteotomy together with static fixation across the non-union fracture site of the neck to avoid delayed femoral neck shortening. All patients were classified as Pauwel's type III fractures. The mean time interval between the last operation and the current procedure was 4.6 months. Average operative time was 58.6 minutes. Patients were followed up for an average of 43.6 months. Complete union was achieved in all cases at an average of 4.3 months. Significant improvement of all radiological parameters was noticed together with the Harris hip score from an average of 21.2 pre-operatively to 89.6 at the last follow-up. The present study provides encouraging clinical and functional results to suggest that this newly described procedure ('triple attack') might be a valuable option in the management of non-united femoral neck fractures.

Bone Marrow Transplantation Followed by Growth Factors Injection in a Patient with Femoral Neck Nonunion: A Case Report

Background: Most fractures of femoral neck typically heal, but a significant proportion of fractures fail to heal, resulting in aseptic bone necrosis, delayed union or persistent nonunion. Specially, nonunion of fractured neck of femur in young adults is a serious problem. Some preclinical evidences show the therapeutic potential of autologous bone marrow for bone fracture healing; however, clinical outcome following of transplantation of bone marrow cells in patients with femoral neck nonunion has never been reported. Case description: We describe a 57-year-old male who had a femoral neck nonunion and received autologous bone marrow transplantation, followed by growth factors injection. The primary endpoint of this study is to achieve radiological fracture healing (union) by evaluating anteroposterior images taken after and on 6th month, following bone marrow therapy and no serious adverse event occurred. Literature review: To our knowledge, this is the first case in the literature of nonunion of femoral neck fracture treated with percutaneous autologous bone marrow transplantation. Clinical relevance: This case suggests that autologous bone marrow transplantation, followed by plasma rich in growth factors (PRGF) could be considered as an exciting option to treat nonunion in femoral neck fracture.

Transfracture abduction osteotomy: A solution for nonunion of femoral neck fractures

Background:Nonunion and avascular necrosis (AVN) of the femoral head remains one of the major complications following femoral neck fractures. Despite various surgical techniques and internal fixation devices, the incidence of nonunion and AVN has remained unsolved. Neglected nonunion of femoral neck fracture is common in the developing world. Treatment options include rigid internal fixation with or without bone grafting, muscle pedicle bone graft, valgus osteotomy of the proximal femur with or without bone graft, valgus osteotomy or hip arthroplasty. We conducted a retrospective analysis of cases of nonunion of femoral neck fracture treated by transfracture abduction osteotomy (TFAO).Materials and Methods:Over a period of 35 years (1974-2008), 30 patients with nonunion of femoral neck fractures were treated with TFAO over a period of 35 years (1974-2008), All patients were less than 50 years of age. Absence of clinical and radiological signs of union after four months was considered as nonunion. Patients more than 50 years of age were excluded from the study. Union was assessed at 6 months radiologically. Limb length was measured at six months. The mean duration of femoral neck fracture was 19 months (range 4 months 10 years). Results were analyzed in terms of radiological union at six months. Average followup was five years and six months.Results:Consistent union was noted at the followup after six months in 29 cases. One case was lost to followup after five and one-half months postoperatively. However, the fracture had united in this case at the last followup. Average shortening of the limb at six months was 1.9 cm. Average neck shaft angle was 127° (range 120-145°). Five cases went into AVN but were asymptomatic. Two cases required reoperation due to back out of Moore's pins. These were reopened and cancellous screws were inserted in the same tracks.Conclusions:Consistent union of nonunion femoral neck fracture was noted at the followup after six months in 29 cases. The major drawback of the procedure is immobilization of the patient in the hip spica for eight weeks.

Effective treatment of a steroid-induced femoral neck fracture nonunion with a once-weekly administration of teriparatide in a rheumatoid patient: a case report

IntroductionNonunion of femoral neck fractures frequently occurs in elderly patients. In patients with rheumatoid arthritis, reoperation rates after internal fixation of a displaced femoral neck fracture increase by up to 60 %. Revision surgery with arthroplasty is often preferred for nonunion of femoral neck fractures because there are few effective options for conservative treatment. Teriparatide (TPTD) is a human parathyroid hormone analog and the only anabolic drug for the treatment of severe osteoporosis.DiscussionThere are two types of treatment regimens using TPTD: a once-daily administration of recombinant type TPTD and a once-weekly administration of a chemically synthesized type. Although there have been some reports showing that the once-daily recombinant type TPTD was effective for nonunion treatment, the effect of a once-weekly administration of the chemically synthesized type of TPTD is unknown. This report shows the efficacy of the chemically synthesized TPTD for the treatment of femoral neck fracture nonunion in a patient with risk factors that include rheumatoid arthritis and steroid intake.

A retrospective analysis of high risk factors for nonunion of femoral neck fractures

Objective To retrospectively study postoperative nonunion of femoral neck fractures so as to identify high risk factors for their nonunion.Methods A total of 965 patients with complete clinical data out of the 1 323 patients with femoral neck fractures treated by internal fixation with cannulated compression screws from January 2003 to January 2011 were included in the study.Logistic muhiple regression method was used to analyze five factors including patients' age,gender,injury mechanism (whether high energy injury or not),fracture type (with or without displacement) and medical comorbidities [American Society of Anesthesiologists Physical Score (ASAS) grade] and their correlation with fracture healing to investigate the high risk factors for the nonunion of femoral neck fractures.Results Quantitative assay of the factors affecting healing of femoral neck fractures was ranged as follows:medical comorbidities (ASAS grade),injury mechanism (whether high energy injury or not),fracturc type (with or without displacement),gender and age.Conclusion Age ＞ 50 years,females,displacement fracture,high energy injury,and ASAS grade above Ⅲ are high risk factors for nonunion of femoral neck fractures. Key words: Femoral neck fractures; Internal fixators; Fractures, nonunited; Risk factors

Modified Valgus Osteotomy for Treatment of Femoral Neck Fracture Non-Union

Background: Non-union of the femoral neck fracture in young and middle-aged patients is a problem and can be very debilitating. If the femoral head is viable, the most appropriate treatment is valgus osteotomy that without refreshing of the fracture site, it only increases the femoral neck angle to change shearing force to compression force. In this study, after refreshing the non-union site and establishing normal relation between head and neck of the femur, valgus osteotomy was done. Materials and methods: In this case-series study, of all patients who had femoral neck non-union and presented during a 2-year period to Sina Hospital and were less than 60 years of age with a viable femoral head, 22 patients (18 males and 4 females) with a mean age of 34 years (20-47 years) were studied. There were stabilizing screws in 10 patients. The patients were followed up to one year with radiography and were assessed regarding Harris hip score, union, and complications especially femoral head necrosis and the signs of joint destruction and arthrosis. Results: Harris hip scores before and after surgery was 63 and 89, respectively. The angle between the femoral neck and shaft of the femur reached 150 degrees and union was occurred in all patients. Femoral head necrosis happened in 2 cases and in 3 cases following femoral neck collapse, implant tip was entered into the joint which was removed immediately. Mean time of union was 4.5 months. Conclusion: Refreshing the non-union site before valgus osteotomy in femoral neck fracture non-union causes increase in union and less complications.