Quadratus Femoris Muscle Pedicle Bone Research Articles

A modified surgical method for the treatment of ONFH: quadratus femoris muscle pedicle bone grafting with preservation of the posterior superior retinacular artery

BackgroundOsteonecrosis of the femoral head (ONFH) can lead to pain and loss of function of the hip joint, which places a great burden on patients and society. Surgery is the main treatment for osteonecrosis of the femoral head, and quadratus femoris muscle pedicle bone grafting has a definite therapeutic effect as one method of surgery for the treatment of ONFH. However, the posterior superior retinacular artery is often injured during quadratus femoris muscle pedicle bone graft surgery. There is evidence that this artery is extremely important to the femoral head, as injury to this artery will seriously affect the blood supply of the femoral head. Therefore, this situation restricts the clinical application of quadratus femoris muscle pedicle bone grafts. We aimed to explore a new surgical method of quadratus femoris muscle pedicle bone grafting that can preserve the integrity of the posterior superior retinacular artery.MethodsWe modified the traditional quadratus femoris muscle pedicle bone graft and preserved the integrity of the posterior superior retinacular artery. To explore the safety and feasibility of the operation, we simulated the operation on 6 fresh frozen cadavers (12 hips) and measured the related data. We also tried this modified surgical method in the clinic and collected detailed data from the patients.ResultsBy simulating the modified quadratus femoris muscle pedicle bone graft on the hip joints of fresh frozen cadavers, we found that the posterior superior retinacular artery existed in all cadaver specimens and that the sources may be different (MFCA or IGA). In the modified operation, the joint capsule did not need to be cut during the operation; therefore, the integrity of the posterior superior retinacular artery was preserved. The quadratus femoris muscle was exposed via the posterior approach of the hip joint, and then the quadratus femoris muscle pedicle bone flap was chiseled. After the pedicle of the quadratus femoris muscle was loosened properly, the migration distance of the quadratus femoris muscle pedicle bone flap reached 5.89 ± 0.45 (χ ± s) cm. The bone flap was trimmed properly and placed on one side. Next, we drilled a bone tunnel from the external intertrochanteric aspect of the capsule of the hip joint, and the bone tunnel broke through the sclerosing zone and proceeded straight to the necrotic area of the femoral head. Next, the necrotic bone was removed with a ring saw and arc bone knife, autogenous bone or allogeneic bone was filled into the bone groove according to the situation, and the cancellous bone in the bone groove was tamped by percussion. Then, the bone flap was inserted into the bone groove, and appropriate pressurization was performed. The depth of the bone groove was determined by the location of ONFH. We found that the furthest distance between the bone groove and the femoral head was 4.76 ± 0.07 (χ ± s) cm and that the length of the bone flap was (4.91 ± 0.23) (χ ± s) cm. This means that when the depth of the bone groove reached the area of ONFH, the quadratus femoris muscle pedicle bone flap had a sufficient length and migration distance to be embedded in the area of ONFH and firmly fixed, and the quadratus femoris did not have much tension. The closest distance between the posterior superior retinacular artery and the bone groove was (1.11 ± 0.96) (χ ± s) cm. When the bone groove was created in this area, the edge of the bone groove had a safe distance of at least 1 cm from the posterior superior retinacular artery of the femoral head. We attempted to implement this modified operation clinically. During the procedure, the quadratus femoris muscle pedicle bone flap was embedded into the drilled bone groove and fixed with a magnesium nail. There was no sliding of the bone flap after the operation, and the posterior superior retinacular artery was intact. We followed the patient for 3 months and found that the patient recovered well with no weight-bearing by the affected limb. The duration of the modified operation was shorter than that of the traditional quadratus femoris muscle pedicle bone graft, the amount of bleeding was significantly reduced, the postoperative pain was lessened, and no special discomfort was reported. Postoperative imaging examination showed that the collapse of the femoral head had been partially corrected and that the bone flap had gradually fused with the surrounding bone.ConclusionsThrough this experimental study, we confirmed the feasibility of the modified method for quadratus femoris muscle pedicle bone grafting with preservation of the posterior superior retinacular artery. This modified operation not only retains the integrity of the posterior superior retinacular artery of the femoral head but also reduces the difficulty of the operation and shortens the surgical time, which is of great clinical significance.

Comparative Study Between Closed Reduction Internal Fixation Alone Versus Closed Reduction Internal Fixation and Addition of Muscle Pedicle Bone Graft for Prevention of Osteonecrosis in Cases of Displaced Femoral Neck Fractures.

In patients of less than 60years of age, osteosynthesis is the treatment of choice for displaced femoral neck fractures (Garden 3 and 4). Most of these fractures unite well but chances of osteonecrosis are quite high even after early operations and till date there is no well-defined method of prediction and prevention of osteonecrosis. Vascularized bone graft may prevent the development of osteonecrosis. This is a retrospective case control study done in an urban Medical College in eastern India and tried to evaluate efficacy of addition of quadratus femoris muscle pedicle bone graft in cases of osteosynthesis comparing the results of cases treated with closed reduction and internal fixation alone for femoral neck fractures We have taken into consideration 45 consecutive cases from each group with identical demographic background and of very similar age pattern of 20years to 60years.For further reference, we will describe Group I for closed reduction and CHS/DHS only, and Group II for closed reduction CHS and quadratus femoris muscle pedicle graft. Satisfactory bony union occurred in 42 out of 45 follow-up patients in Group 1 (93.3%) and 43 out of 45 patients in Group 2. (95.5%) In 2- to 10-year follow-up period, eight patients (18.6%) developed osteonecrosis in Group I, and in Group 2, in the same period, there were no cases of osteonecrosis. Addition of quadratus femoris muscle pedicle bone graft is a very effective procedure for prevention of osteonecrosis when we attempt osteosynthesis by closed reduction and internal fixation for displaced femoral neck fractures.

Results of quadratus femoris muscle pedicle bone grafting (Meyers' procedure) in the management of ununited femoral neck fractures.

Femoral neck fractures in young patients are associated with increase complication risk. The objective of this study was to evaluate the results of quadratus femoris muscle pedicle grafting in the treatment of ununited femoral neck fractures. This study includes 16 patients with ununited femoral neck fractures treated with quadratus femoris muscle pedicle graft. 7 patients had neglected femoral neck fractures while 9 had ununited femoral neck fractures after fixation. Quadratus femoris muscle with 2 × 1 × 1 cm (length-width-height) bone in its insertion was elevated and placed in the posterior cortex of the femoral neck with additional cancellous graft from the posterior iliac bone. The graft was fixed with 3.5-mm cortical screws. The average follow-up period was 96 weeks and the radiological union occurred at an average of 7 months. The femoral inclination of all patients was 128.5° ± 3.9° with an average 7 (range 0-35) mm thigh atrophy in the last follow-up visit. Only 1 patient (6%) had avascular necrosis of the femoral head and was treated with hip arthroplasty. Quadratus femoris muscle pedicle grafting provides better stability and blood supply in ununited femoral neck fractures. Achieving fracture union provides better clinical and functional results in the treatment of femoral neck fractures.

A cross sectional study of outcomes of muscle pedicle grafting in neck of femur fractures and avascular necrosis of femoral head

Avascular necrosis (AVN) of the femoral head is a progressive disease that generally affects patients in the second through fifth decades of life; if left untreated, it leads to complete deterioration of the hip joint. Treatments range from simple decompression of the femoral head, to muscle pedicle bone grafting of the involved area, or by using a vascularized fibular graft with varying degree of success. If the disease have progresses further causing secondary arthritis, Total Hip Arthroplasty may be necessary.We present a study of management of 60 young patients aged less than 50 years having either early stage AVN (stage I and II A/B of Ficat & Arlet classification) or Neck of the femur fractures, treated with quadratus femoris muscle pedicle bone grafting & cancellous screws. With aim To evaluate the results of the above modality in the management of AVN of the hip & neck femur fractures and to study the radiological & functional outcome of the procedure in young patients.

Quadratus femoris muscle pedicle bone flap transplantation in the treatment of femoral neck fracture for Chinese young and middle-aged patients: A systematic review and meta-analysis

PurposeTo compare the efficacy of quadratus femoris muscle pedicle bone flap transplantation combined with hollow compression screw fixation versus AO hollow compression screw fixation in the treatment of femoral neck fracture for Chinese young and middle-aged patients. MethodsCase-controlled studies (CCTs) were used to compare the two operative methods in the treatment of femoral neck fractures. Data were retrieved from the Cochrane Library, Pubmed Database, CNKI, Chinese Biomedical Database.Wanfang Data published during the period of January 2005 to December 2014. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical Software Revman 5.0 was used for data-analysis. ResultsEight articles were included in the meta-analysis. The results showed that there was statistical significance in the rate of fracture healing [OR = 5.43, 95% CI (2.89, 10.20), p < 0.05], the rate of good function of hip joint [OR = 5.12, 95% CI (3.21, 8.17), p < 0.05], the rate of femoral head necrosis [OR = 4.21, 95% CI (2.02, 8.76), p < 0.05], the time of fracture healing [WMD = −46.85, 95% CI (−65.13, −28.56), p < 0.05] between the two groups. ConclusionsFor the treatment of femoral neck fractures, the transplantation of quadratus femoris muscle pedicle bone flap combined with hollow compression screw; fixation is superior to the AO hollow compression screw fixation in terms of the rate; of fracture healing, the rate of good function of hip joint, the rate of femoral head; necrosis and the time of fracture healing.

Core decompression or quadratus femoris muscle pedicle bone grafting for nontraumatic osteonecrosis of the femoral head: A randomized control study.

Background:The traditional management for osteonecrosis of the femoral head (ONFH) includes core decompression (CD) and quadratus femoris muscle pedicle bone graft (QF-MPBG). The aim of this study was to investigate the effects of CD and QF-MPBG on the patients with nontraumatic ONFH in an early stage.Materials and Methods:39 patients (47 hips) with ONFH in an early stage (Ficat Stage I or II) were randomly divided into two groups according to random number table method. One group was treated with CD and cancellous bone grafting. Another group was treated QF-MPBG with cancellous bone grafting. The hip function was evaluated using Harris hip score (HHS). The repair of the femoral head was estimated through X-ray, computed tomography (CT), or magnetic resonance imaging (MRI). The surgical time and intraoperative blood loss was calculated.Results:All patients were followed for an average 2.5 years (range from 1.5 to 4 years). Two hips in CD group progressed into stage 3 and three hips in QF-MPBG group processed into stage 3. No patient accepted the THA at the last followup. The HHSs significantly increased in both groups after surgery (P < 0.05). No statistical differences were found between CD and QF-MPBG groups in postoperative HHSs at last followup (P > 0.05). X-ray and CT showed that the femoral head did not progress to collapse after operation in both groups. In addition, MRI showed that the edema signals decreased. However, the surgical time was longer in QF-MPBG group than that in CD group (P < 0.05). The intraoperative blood loss was more in QF-MPBG than that in CD group (P < 0.05).Conclusion:The CD with bone graft could relieve hip pain, improve hip function with much lesser surgical trauma compared to QF-MPBG. Hence, the CD with bone graft should be generally used for the treatment of patients with an early stage (Ficat Stage I or II) ONFH.

Meta-analysis of quadratus femoris muscle pedicle bone flap transplantation in the repair of femoral neck fracture for young and middle-aged patients

Objective To compare the efficacy of quadratus femoris muscle pedicle bone flap transplantation combined with hollow compression screw fixation versus hollow compression screw fixation in the repair of femoral neck fracture for young and middle-aged patients. Methods Case-controll studies comaring the quadratus femoris muscle pedicle bone flap transplantation with hollow compression screw fixation in the repair of femoral neck fracture were retrieved from CNKI, Chinese Biomedical Database, Wanfang Data and manually (from January, 2005 to December, 2014). Methodological quality of the trials was critically assessed, and relevant data were extracted. Statidtical software Revman 5.0 was used for data-analysis. Results Eight articles were included in the meta-analysis. The results showed that, compared the efficacy of quadratus femoris muscle pedicle bone flap transplantation combined with hollow compression screw fixation with hollow compression screw fixation,there were statidtical significance in the rate of fracture healing [OR= 5.43, 95%CI(2.89, 10.20), P < 0.05], the rate of good function of hip joint [OR= 5.12, 95%CI(3.21, 8.17), P < 0.05], the rate of femoral head necrosis [OR= 4.21,95%CI(2.02,8.76), P < 0.05], the time of fracture healing [WMD=-46.85, 95%CI(-65.13, -28.56), P < 0.05]. Conclusion The transplantation of quadratus femoris muscle pedicle bone flap combined with hollow compression screw fixation is superior to the hollow compression screw fixation in the repair of femoral neck fracture for young and middle-aged patients in regards to the rate of fracture healing, the rate of good function of hip joint, the rate of femoral head necrosis, the time of fracture healing. Key words: Femoral neck fracture; Quadratus femoris muscle pedicle bone flap; Hollow compression screw fixation; Meta-analysis

Role of muscle pedicle bone graft as an adjunct to open reduction and internal fixation in the management of neglected and ununited femoral neck fracture in young adults: a prospective study of 17 cases

To evaluate the role of quadratus femoris muscle pedicle bone grafting along with open reduction and internal fixation in the treatment of neglected and ununited femoral neck fractures in young adults. Young adults within the age group of 15-45 years with ununited, old neglected fractures of femoral neck were included in the study. All patients underwent quadratus femoris muscle pedicle bone grafting along with open reduction and internal fixation. The post-operative complications and functional recovery was assessed using Charnley's modification of Merle D'Aubigne and Postel hip scoring. A total of 17 patients were included in the study. The average time of union following the procedure was found to be approximately 8 months. There were two cases of delayed union and no cases of avascular necrosis. Ten patients (58.8%) had excellent or very good post-operative functional results and 6 patients (35.3%) had good or satisfactory results. Muscle pedicle bone grafting is a useful adjunct to open reduction and internal fixation for ununited femoral neck fractures. It achieves good final functional results comparable with other methods, but requires greater expertise.

The medium and long term effects of the quadratus femoris muscle pedicle bone graft with screw internal fixation for the treatment of femoral neck fractures in youth

Objective To analysis the medium and long term effects of the quadratus femoris muscle pedicle bone graft with screw internal fixation for the treatment of femoral neck fractures in adults.Methods From March 2003 to December 2008,sixty-two patients with femoral neck fractures were operated.There were 50 males and 12 females,with an average age of 39 years (ranged from 16 to 62 years).Fifteen cases suffered from traffic accidents and 47 from falling injury.There were 8 cases which fracture site was infer-head in Garden type Ⅱ,twenty-nine cases in type Ⅲ and 25 cases in type Ⅳ.The average time were 12 hours (2-96 hours) from injured to hospital admission and 4 days (2-8 days) from injured to operation.Partial weight bearing started on 3 months postoperatively and full weight bearing on 6 months.The postoperative duration of follow up was 3 to 5 years in 39 cases.Healing of fractures and avascular necrosis of the femoral head were evaluated based on the X-ray results or MRI if necessary.The pain,function,deformity,range of motion were evaluated based on Harris joint function scores.Results Nonunion of fracture was noted in 2 cases during the follow-up period.The fracture healing rate was 96.8％.The avascular necrosis of the femoral head was noted in 6 cases (15.4％).There were statistical significant differences between 3 months of postoperation and 3 years of postoperation in the pain,function,deformity,range of motion.After 3 years of postoperation,there were excellent in 29 cases,good in 6 cases,general in 1 case,poor in 3 cases according to Harris joint function scores.Conclusion This technique is relatively simple and has high rate of fracture healing.The avascular necrosis of the femoral head rate is low.The medium-and long-term results are satisfactory. Key words: Femoral neck fractures; Bone transplantation; Fracture Internal Fixation; Microsurgical operation

Management of ununited intracapsular femoral neck fractures by using quadratus femoris muscle pedicle bone grafting in young patients

Intracapsular femoral neck fracture with delayed presentation in young patients can pose surgical challenge. Such scenarios are rare in developed countries, but common in developing countries. We retrospectively reviewed the records and radiographs of 42 patients (28 males and 14 females) with ununited intracapsular femoral neck fracture who presented late to our unit. These subjects were managed by open reduction and internal fixation that was supplemented with cortico-cancellous bone graft from posterior iliac crest as well as quadratus femoris muscle pedicle bone graft. The mean delay in presentation was 9 months (range 3-18 months) after the fracture. The mean age of the patients at index procedure was 34 years (range 24-51 years). Radiological union occurred on average at 6 months (range 3-13 months). Thirty-six hip fractures (86%) proceeded to union. Six patients (14%) had non-union and needed revision surgery. Complications included varus union in 9 patients and leg length discrepancy with a mean of 1.5 cm (range 1 to 2.5 cm) in 10 patients. For the ununited intracapsular femoral neck fracture, favorable results can be achieved by anatomical reduction of the fracture, cortico-cancellous bone grafting to reconstruct the femoral neck, internal fixation with cancellous screws, and augmentation with quadratus femoris muscle pedicle bone graft.

Closed reduction, internal fixation with quadratus femoris muscle pedicle bone grafting in displaced femoral neck fracture

Background:Management of femoral neck fracture is still considered as an unsolved problem. It is more evident in displaced fractures where this fracture is considered as some sort of vascular insult to the head of the femur. We have used closed reduction, internal fixation and quadratus femoris muscle pedicle bone grafting in fresh displaced femoral neck fractures.Materials and Methods:From April 1996 to December 2004 we operated 73 consecutive patients of displaced femoral neck fracture in the age group of 24 to 81 years, mean age being 54.6 years. The patients were operated within one week of injury, the mean delay being 3.6 days. Closed reduction internal fixation along with quadratus femoris muscle pedicle bone grafting was done in all cases. They were followed up for an average period of 5.6 years (range 2-11 years).Results:Results were assessed according to modified Harris Hip Scoring system and found to be excellent in 53, good in 12, fair in six and poor in two patients. Bony union occurred in 68 cases, no patient developed avascular necrosis (AVN) till date.Conclusion:For fresh displaced femoral neck fracture in physiologically active patients closed reduction, internal fixation and quadratus femoris muscle pedicle bone grafting is a suitable option to secure union and prevent development of AVN.

A Cliniral Experience of Quadratus Femoris Muscle Pedicle Bone Graft in Nonunion and PatHologic Fracture of the Neck of Femur

A Cliniral Experience of Quadratus Femoris Muscle Pedicle Bone Graft in Nonunion and PatHologic Fracture of the Neck of Femur

Treatment of Complicated Femoral Neck Fractures in Children by Quadratus Femoris Muscle Pedicle Bone Graft: A Preliminary Report of 4 Cases

Treatment of Complicated Femoral Neck Fractures in Children by Quadratus Femoris Muscle Pedicle Bone Graft: A Preliminary Report of 4 Cases

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

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.