Un-United Fracture Neck Femur Results of Treatment with Close Reduction, Cancellous Screw Fixation & Fibular Strut Graft
Background: Ununited, femur neck fractures are a common problem in the developing countries like India where medical facilities are already deficient and ignorance, illiteracy and poverty further delay the patients in seeking proper treatment. The struggle to find the best treatment continues as relentlessly as it did half a century ago. The study was undertaken to evaluate the results of close reduction, cancellous screw fixation and fibular graft in ununited fractures of femoral neck in young adults with regards to achievement of fracture union, effect of this procedure on pre-existing AVN and establishment of relatively easy new surgical technique.
Materials & Methods: This study was conducted in Government hospital, Pali, Rajasthan. It includes 25 cases treated by close reduction, cancellous screw fixation and fibular strut graft who have non-united fracture. The patients are systemically interrogated for personal details, mode of injury, time elapsed after injury, complaints, any other associated injury, any previous treatment taken and other systemic illness. Grading of fracture (Garden’s classification) resorption of neck and avascular necrosis changes are based on roentgen graphic findings.
Results: Our study showed that the mean age of patients was 35.19 years and maximum patients were seen in 21-40 years of age (72%), male to female ratio was 2.57:1. Average union time in our series was 19 weeks. In present series good to excellent results found in 96% of cases; in only one case (4%) result was poor that was because of failure of procedure.
Conclusion: We concluded that the cancellous screws fixed in closed reduced fracture and supplemented with fibular strut graft is one of the good methods as far as union and functional results are concerned in ununited fractures of femoral neck.
2. Mayers M.H., Harvey J.P. Jr., Moore T.M.: Treatment of displaced subcapital and transcervical fractures of femoral neck by muscle pedicle bone graft and internal fixation; J.B.J.S,1973;55A:257.
3. Reich R.S.: Ununited fracture of the neck of the femur treated by high oblique osteotomy; JBJS,Jan 1941;14 (4): 141-158.
4. Chaudhary A.K., Chatterjee ND, Baksi DP: Different osteotomies and internal fixation combined with muscle pedicle bone grafting in treatment of ununited femoral neck fractures: A comparative study. IJO,Jan 1992;26 (1).
5. Pandey S.; Intracapsular fracture of the femur neck treated by open reduction, S.P. nailing and iliopsoas release; International Surgery; 1971;55 (43).
6. Whitmann R: A new method of treatment for fracture of neck of the femur together with remarks on coxavera: Am Surg,1902:36:746.
7. Senn N; Fracture of the neck of the femur with special references to bony union after intracapsular fractures: Trans. Am surg. Asso. 1883;1:333-341.
8. Nagi G.N., Gautam V.K., Marya SKS: Treatment of femoral neck fracture with cancelloius screw and fibular graft; JBJS, March 1986: 68B: 387-391.
9. Mishra D. Femoral neck fractures open reduction, Asnis screw fixation and fibular grafting. IJO, Jan 1998: 32:32-35