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Fibular strut graft for nonunited femoral neck fractures in children

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

Final position of the fracture and the graft into the femoral neck (lateral view).
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Figure 10: Final position of the fracture and the graft into the femoral neck (lateral view).

Mentions: A guidewire was inserted in the centre of the neck in both AP and lateral views and used as a guide for insertion of the fibular graft (Fig. 6). After the guidewire has been positioned satisfactorily, reaming over the guidewire was done using the distal part of the triple reamer of dynamic hip screw (8 mm) (Fig. 7). A fibular graft was harvested from the ipsi-lateral leg using a posterolateral approach as described by Nagi and Dhillon.8 The periosteum over the lateral border of the fibula was cut and a 10-cm long segment of bone was exposed. In order to avoid troublesome bleeding, we did not strip the periosteum from the medial aspect. We also removed only the lateral two-thirds of the bone, ensuring that we stayed subperiosteally, and left behind a tube of soft tissue and periosteum that could be stitched back. The bone was cut with an oscillating saw, leaving the inter-osseous border intact. Careful resuturing of the periosteal tube and leaving behind the intact interosseous border allowed a better regrowth of the bone, did not affect ankle stability and minimised bleeding from vessels in the area of the interosseous membrane. Bone (10 cm in length) was taken out and drill holes using a 2.5 mm drill bit were made at regular intervals 2 cm apart on its surfaces for incorporation of the graft. The leading edge of the graft was bevelled for about 1 cm and impacted over the guidewire into the femoral neck using a graft impactor to a subphyseal position (Figs 8 to 10). When a child was aged more than ten years (three cases), we penetrated the physis and placed the fixation across the epiphysis. In older children with little growth potential remaining, achievement of stability and avoidance of complications associated with late displacement do outweigh the sequlae of premature physeal closure.


Fibular strut graft for nonunited femoral neck fractures in children
Final position of the fracture and the graft into the femoral neck (lateral view).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 10: Final position of the fracture and the graft into the femoral neck (lateral view).
Mentions: A guidewire was inserted in the centre of the neck in both AP and lateral views and used as a guide for insertion of the fibular graft (Fig. 6). After the guidewire has been positioned satisfactorily, reaming over the guidewire was done using the distal part of the triple reamer of dynamic hip screw (8 mm) (Fig. 7). A fibular graft was harvested from the ipsi-lateral leg using a posterolateral approach as described by Nagi and Dhillon.8 The periosteum over the lateral border of the fibula was cut and a 10-cm long segment of bone was exposed. In order to avoid troublesome bleeding, we did not strip the periosteum from the medial aspect. We also removed only the lateral two-thirds of the bone, ensuring that we stayed subperiosteally, and left behind a tube of soft tissue and periosteum that could be stitched back. The bone was cut with an oscillating saw, leaving the inter-osseous border intact. Careful resuturing of the periosteal tube and leaving behind the intact interosseous border allowed a better regrowth of the bone, did not affect ankle stability and minimised bleeding from vessels in the area of the interosseous membrane. Bone (10 cm in length) was taken out and drill holes using a 2.5 mm drill bit were made at regular intervals 2 cm apart on its surfaces for incorporation of the graft. The leading edge of the graft was bevelled for about 1 cm and impacted over the guidewire into the femoral neck using a graft impactor to a subphyseal position (Figs 8 to 10). When a child was aged more than ten years (three cases), we penetrated the physis and placed the fixation across the epiphysis. In older children with little growth potential remaining, achievement of stability and avoidance of complications associated with late displacement do outweigh the sequlae of premature physeal closure.

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