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Fibular strut graft for nonunited femoral neck fractures in children

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ABSTRACT

Purpose: To 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.

Methods: A 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.

Results: The 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.

Conclusions: Fibular 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.

No MeSH data available.


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Nonunited femoral neck fracture with neck-shaft angle less than 110°.
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Figure 1: Nonunited femoral neck fracture with neck-shaft angle less than 110°.

Mentions: This was a retrospective study of 12 children (nine males, three females), with a mean age of 8.2 years (5 to 12), who had isolated nonunited femoral neck fractures. All were admitted to Mansoura University Hospital, Egypt, for operative intervention over a two-year period between July 2013 and July 2015. All fractures were older than six months with an evident gap with or without resorption on radiographs. All children were treated by fibular strut grafts with or without subtrochanteric valgus osteotomy and were followed up for a minimum of 12 months. The aim of surgery was to heal the nonunion, restore the length of the femoral neck and lower limb by using fibular strut  grafts with subtrochanteric valgus osteotomy if the neck-shaft angle was less than 110° (Figs 1 and 2) and without osteotomy if the neck-shaft angle was greater than 110° (Figs 3 to 5).


Fibular strut graft for nonunited femoral neck fractures in children
Nonunited femoral neck fracture with neck-shaft angle less than 110°.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5382333&req=5

Figure 1: Nonunited femoral neck fracture with neck-shaft angle less than 110°.
Mentions: This was a retrospective study of 12 children (nine males, three females), with a mean age of 8.2 years (5 to 12), who had isolated nonunited femoral neck fractures. All were admitted to Mansoura University Hospital, Egypt, for operative intervention over a two-year period between July 2013 and July 2015. All fractures were older than six months with an evident gap with or without resorption on radiographs. All children were treated by fibular strut grafts with or without subtrochanteric valgus osteotomy and were followed up for a minimum of 12 months. The aim of surgery was to heal the nonunion, restore the length of the femoral neck and lower limb by using fibular strut  grafts with subtrochanteric valgus osteotomy if the neck-shaft angle was less than 110° (Figs 1 and 2) and without osteotomy if the neck-shaft angle was greater than 110° (Figs 3 to 5).

View Article: PubMed Central - PubMed

ABSTRACT

Purpose: To 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.

Methods: A 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.

Results: The 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.

Conclusions: Fibular 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.

No MeSH data available.


Related in: MedlinePlus