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Augmented osteosynthesis with tensor fascia latae muscle pedicle bone grafting in neglected femoral neck fracture

BACKGROUND: Neglected intracapsular femoral neck fracture in young patients may fail to unite because of the excessive shearing strain at the fracture site and it is a surgical challenge to any orthopedic surgeon. The problem is compounded by resorption of the femoral neck and avascular necrosis (AV...

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Autor principal: Bhuyan, Basant Kumar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3421935/
https://www.ncbi.nlm.nih.gov/pubmed/22912520
http://dx.doi.org/10.4103/0019-5413.97263
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author Bhuyan, Basant Kumar
author_facet Bhuyan, Basant Kumar
author_sort Bhuyan, Basant Kumar
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description BACKGROUND: Neglected intracapsular femoral neck fracture in young patients may fail to unite because of the excessive shearing strain at the fracture site and it is a surgical challenge to any orthopedic surgeon. The problem is compounded by resorption of the femoral neck and avascular necrosis (AVN) of femoral head. There is no satisfactory solution available in the management of femoral neck fracture as far as the union of the fracture and AVN of femoral head are concerned. Muscle pedicle bone grafting has been advocated to provide additional blood supply to the femoral head. We report a retrospective analysis of 48 cases of neglected femoral neck fracture treated by internal fixation and tensor fascia latae based muscle pedicle bone grafting. MATERIALS AND METHODS: 48 patients with femoral neck fractures with age varied from 20 to 53 years (average age 32.9 years) with male to female ratio of 2:1 were enrolled. All fractures were more than 3 weeks old with mean delay being 86 days (22–150 days). Open reduction and internal fixation along with tensor fascia latae muscle pedicle bone grafting was done in all cases. It was supplemented by multiple drilling and cortico-cancellous bone grafting. Fracture fixation was done with three parallel 6.5-mm AO cannulated cancellous lag screws and the graft fixed with a 4-mm cancellous screw to provide a secure fixation. During the followup period of 2-6.8 years (average 4.4 years) the results were assessed clinically by modified Harris hip scoring system and radiologically by the evidence of signs of fracture union. RESULTS: Union was achieved in 41/48 (85.41%) cases which were followed for an average period of 4.4 years (2–6.8 years) with good functional results and ability to squat and sit cross-legged. Results were assessed according to modified Harris Hip Scoring system and found to be excellent in 19, good in 22, fair in 5, and poor in 2 patients. Complications were nonunion, (n=3) avascular necrosis (n=2), and coxa vara deformity (n=2). CONCLUSION: Internal fixation with muscle pedicle bone grafting is a suitable option to secure union in neglected femoral neck fractures in physiologically active patients with late presentation.
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spelling pubmed-34219352012-08-21 Augmented osteosynthesis with tensor fascia latae muscle pedicle bone grafting in neglected femoral neck fracture Bhuyan, Basant Kumar Indian J Orthop Original Article BACKGROUND: Neglected intracapsular femoral neck fracture in young patients may fail to unite because of the excessive shearing strain at the fracture site and it is a surgical challenge to any orthopedic surgeon. The problem is compounded by resorption of the femoral neck and avascular necrosis (AVN) of femoral head. There is no satisfactory solution available in the management of femoral neck fracture as far as the union of the fracture and AVN of femoral head are concerned. Muscle pedicle bone grafting has been advocated to provide additional blood supply to the femoral head. We report a retrospective analysis of 48 cases of neglected femoral neck fracture treated by internal fixation and tensor fascia latae based muscle pedicle bone grafting. MATERIALS AND METHODS: 48 patients with femoral neck fractures with age varied from 20 to 53 years (average age 32.9 years) with male to female ratio of 2:1 were enrolled. All fractures were more than 3 weeks old with mean delay being 86 days (22–150 days). Open reduction and internal fixation along with tensor fascia latae muscle pedicle bone grafting was done in all cases. It was supplemented by multiple drilling and cortico-cancellous bone grafting. Fracture fixation was done with three parallel 6.5-mm AO cannulated cancellous lag screws and the graft fixed with a 4-mm cancellous screw to provide a secure fixation. During the followup period of 2-6.8 years (average 4.4 years) the results were assessed clinically by modified Harris hip scoring system and radiologically by the evidence of signs of fracture union. RESULTS: Union was achieved in 41/48 (85.41%) cases which were followed for an average period of 4.4 years (2–6.8 years) with good functional results and ability to squat and sit cross-legged. Results were assessed according to modified Harris Hip Scoring system and found to be excellent in 19, good in 22, fair in 5, and poor in 2 patients. Complications were nonunion, (n=3) avascular necrosis (n=2), and coxa vara deformity (n=2). CONCLUSION: Internal fixation with muscle pedicle bone grafting is a suitable option to secure union in neglected femoral neck fractures in physiologically active patients with late presentation. Medknow Publications & Media Pvt Ltd 2012 /pmc/articles/PMC3421935/ /pubmed/22912520 http://dx.doi.org/10.4103/0019-5413.97263 Text en Copyright: © Indian Journal of Orthopaedics http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Bhuyan, Basant Kumar
Augmented osteosynthesis with tensor fascia latae muscle pedicle bone grafting in neglected femoral neck fracture
title Augmented osteosynthesis with tensor fascia latae muscle pedicle bone grafting in neglected femoral neck fracture
title_full Augmented osteosynthesis with tensor fascia latae muscle pedicle bone grafting in neglected femoral neck fracture
title_fullStr Augmented osteosynthesis with tensor fascia latae muscle pedicle bone grafting in neglected femoral neck fracture
title_full_unstemmed Augmented osteosynthesis with tensor fascia latae muscle pedicle bone grafting in neglected femoral neck fracture
title_short Augmented osteosynthesis with tensor fascia latae muscle pedicle bone grafting in neglected femoral neck fracture
title_sort augmented osteosynthesis with tensor fascia latae muscle pedicle bone grafting in neglected femoral neck fracture
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3421935/
https://www.ncbi.nlm.nih.gov/pubmed/22912520
http://dx.doi.org/10.4103/0019-5413.97263
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