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Biodegradable magnesium screws and vascularized iliac grafting for displaced femoral neck fracture in young adults.

Yu X, Zhao D, Huang S, Wang B, Zhang X, Wang W, Wei X - BMC Musculoskelet Disord (2015)

Bottom Line: Clinical and radiological outcomes were evaluated.No patient developed avascular necrosis of femoral head after operation.Biodegradable magnesium screws and vascularized iliac grafting based on the ascending branch of lateral femoral circumflex artery for displaced femoral neck fracture in young adults can provide the satisfactory results with a low rate of complications including avascular necrosis and nonunion.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, The Affiliated Zhongshan Hospital of Dalian University, No. 6 Jiefang Street, Dalian, Liaoning, 116001, China.

ABSTRACT

Objective: Avascular necrosis of femoral head and nonunion is a major complication after the treatment of displaced femoral neck fracture in young adults. The purpose of this study was to introduce a new technique using biodegradable magnesium screws and vascularised iliac grafting for displaced femoral neck fracture in young adults.

Methods: Totally 19 patients with displaced femoral neck fracture treated with this technique were retrospectively reviewed. The major steps of this technique included the harvesting of vascularized iliac graft, fixing of the fracture and biodegradable magnesium screws combined with vascularized iliac grafting implantation.

Results: All patients were followed for an average of 16 months (range: 8-24 months). Clinical and radiological outcomes were evaluated. In 18 cases (94.7 %), the hip union was achieved at an average duration of 4.1 months (range: 3.6-5 months). The nonunion was observed in 1 hip (5.3 %) and the revision to a hip replacement was conducted after twelve months of the operation. According to the Harris hip score (HHS) that was available for 17 hips with satisfactory union, excellent results were achieved in 14 cases (HHS ≥ 90), fair results in 3 cases (HHS: 80-90), and poor result in 1 hip (HHS < 80). No patient developed avascular necrosis of femoral head after operation.

Conclusion: Biodegradable magnesium screws and vascularized iliac grafting based on the ascending branch of lateral femoral circumflex artery for displaced femoral neck fracture in young adults can provide the satisfactory results with a low rate of complications including avascular necrosis and nonunion.

Trial registration: This prospective and randomized controlled study was registered in the Chinese Clinical Trial Registry ( ChiCTR-TRC-13003238). Date of registration: 2013-3-21.

No MeSH data available.


Related in: MedlinePlus

Diagrammatic representation of the operative technique.1.Magnesium screws and vascularised iliac grafting.2.Cannulated compression scrows
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Fig2: Diagrammatic representation of the operative technique.1.Magnesium screws and vascularised iliac grafting.2.Cannulated compression scrows

Mentions: The surgical technique has been previously described [14, 15]. A double-curved incision with 12 cm in length was made along the line connecting the anterior superior iliac spine (ASIS) and the lateral margin of the patella, with the proximal end of the incision running along the iliac crest and extending 4 cm beyond the ASIS. Briefly, two cannulated compression screws were inserted with one positioned superiorly in femoral head and the other inferiorly in the head passing just above the calcar, in order to retain sufficient space for the pedicled graft. The sartorius and the origin of rectus femoris were then partially released and the tensor fascia lata was retracted to expose the ascending branch of the lateral circumflex femoral artery. The separation was extended proximally towards the iliac crest to the origin of the tensor. Part of the iliac crest, approximately 5 cm in length and 3 cm in width, was then exposed laterally from the ASIS with a vascular pedicle long enough to enable rotation of the graft to femoral neck. The anterolateral capsule of femoral head and neck was incised in a T-shape, avoiding the inferior part of the femoral neck in order to protect the basilar section of the arterial ring. An osteotome was used to create a supero-lateral cortical window of approximately 2 cm × 2 cm, at the femoral head-neck junction. The previously harvested vascularised bone graft was impacted into the femoral neck. During insertion, we took care not to compress the soft-tissue cuff containing the vessels to the bone graft. Vascularized iliac grafting was fixed by biodegradable magnesium screws (Figs. 1 and 2). Skin traction was applied post-operatively to the leg to maintain the hip in 30° abduction in a neutral position for three weeks. The patients received prophylactic antibiotics including traction for two weeks and cephalosporins for 24 h and non-steroidal anti-inflammatory medication was used for post-operative analgesia. Active exercise for the quadriceps should be initiated after 24 h of the operation. Patients could undertake active abduction/adduction exercise of the hip with 20–30 repetitions and three times each day. Non-weight bearing mobilisation proceeded as comfort permitted and toe-touch weight-bearing started three weeks after the operation. Two crutches were exchanged for 12 months after the operation depending on the radiological findings, which was examined by highly qualified radiologists.Fig. 1


Biodegradable magnesium screws and vascularized iliac grafting for displaced femoral neck fracture in young adults.

Yu X, Zhao D, Huang S, Wang B, Zhang X, Wang W, Wei X - BMC Musculoskelet Disord (2015)

Diagrammatic representation of the operative technique.1.Magnesium screws and vascularised iliac grafting.2.Cannulated compression scrows
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4631087&req=5

Fig2: Diagrammatic representation of the operative technique.1.Magnesium screws and vascularised iliac grafting.2.Cannulated compression scrows
Mentions: The surgical technique has been previously described [14, 15]. A double-curved incision with 12 cm in length was made along the line connecting the anterior superior iliac spine (ASIS) and the lateral margin of the patella, with the proximal end of the incision running along the iliac crest and extending 4 cm beyond the ASIS. Briefly, two cannulated compression screws were inserted with one positioned superiorly in femoral head and the other inferiorly in the head passing just above the calcar, in order to retain sufficient space for the pedicled graft. The sartorius and the origin of rectus femoris were then partially released and the tensor fascia lata was retracted to expose the ascending branch of the lateral circumflex femoral artery. The separation was extended proximally towards the iliac crest to the origin of the tensor. Part of the iliac crest, approximately 5 cm in length and 3 cm in width, was then exposed laterally from the ASIS with a vascular pedicle long enough to enable rotation of the graft to femoral neck. The anterolateral capsule of femoral head and neck was incised in a T-shape, avoiding the inferior part of the femoral neck in order to protect the basilar section of the arterial ring. An osteotome was used to create a supero-lateral cortical window of approximately 2 cm × 2 cm, at the femoral head-neck junction. The previously harvested vascularised bone graft was impacted into the femoral neck. During insertion, we took care not to compress the soft-tissue cuff containing the vessels to the bone graft. Vascularized iliac grafting was fixed by biodegradable magnesium screws (Figs. 1 and 2). Skin traction was applied post-operatively to the leg to maintain the hip in 30° abduction in a neutral position for three weeks. The patients received prophylactic antibiotics including traction for two weeks and cephalosporins for 24 h and non-steroidal anti-inflammatory medication was used for post-operative analgesia. Active exercise for the quadriceps should be initiated after 24 h of the operation. Patients could undertake active abduction/adduction exercise of the hip with 20–30 repetitions and three times each day. Non-weight bearing mobilisation proceeded as comfort permitted and toe-touch weight-bearing started three weeks after the operation. Two crutches were exchanged for 12 months after the operation depending on the radiological findings, which was examined by highly qualified radiologists.Fig. 1

Bottom Line: Clinical and radiological outcomes were evaluated.No patient developed avascular necrosis of femoral head after operation.Biodegradable magnesium screws and vascularized iliac grafting based on the ascending branch of lateral femoral circumflex artery for displaced femoral neck fracture in young adults can provide the satisfactory results with a low rate of complications including avascular necrosis and nonunion.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, The Affiliated Zhongshan Hospital of Dalian University, No. 6 Jiefang Street, Dalian, Liaoning, 116001, China.

ABSTRACT

Objective: Avascular necrosis of femoral head and nonunion is a major complication after the treatment of displaced femoral neck fracture in young adults. The purpose of this study was to introduce a new technique using biodegradable magnesium screws and vascularised iliac grafting for displaced femoral neck fracture in young adults.

Methods: Totally 19 patients with displaced femoral neck fracture treated with this technique were retrospectively reviewed. The major steps of this technique included the harvesting of vascularized iliac graft, fixing of the fracture and biodegradable magnesium screws combined with vascularized iliac grafting implantation.

Results: All patients were followed for an average of 16 months (range: 8-24 months). Clinical and radiological outcomes were evaluated. In 18 cases (94.7 %), the hip union was achieved at an average duration of 4.1 months (range: 3.6-5 months). The nonunion was observed in 1 hip (5.3 %) and the revision to a hip replacement was conducted after twelve months of the operation. According to the Harris hip score (HHS) that was available for 17 hips with satisfactory union, excellent results were achieved in 14 cases (HHS ≥ 90), fair results in 3 cases (HHS: 80-90), and poor result in 1 hip (HHS < 80). No patient developed avascular necrosis of femoral head after operation.

Conclusion: Biodegradable magnesium screws and vascularized iliac grafting based on the ascending branch of lateral femoral circumflex artery for displaced femoral neck fracture in young adults can provide the satisfactory results with a low rate of complications including avascular necrosis and nonunion.

Trial registration: This prospective and randomized controlled study was registered in the Chinese Clinical Trial Registry ( ChiCTR-TRC-13003238). Date of registration: 2013-3-21.

No MeSH data available.


Related in: MedlinePlus