The 2003 Annual Meeting of OASYS_NEW

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Non-Union of Femoral Neck Fractures with Avascular Necrosis of the Femoral Head: Treatment with Free Vascularized Fibular Graft Combined with Subtrochanteric Valgus Osteotomy

Beris A, Kostopoulos B, Payatakes A, Korobilias A, and Soucacos P. Department of Orthopaedic, University of Ioannina, Medical School, Ioannina, Greece

Non-union and avascular necrosis of the femoral head are the main complications of fractures of the femoral neck. Treatment in young adults is very difficult as arthroplasty is not indicated. A technique is described using a free vascularized fibular graft to promote healing and to prevent osteonecrosis, combined with valgus subtrochanteric osteotomy to convert shearing forces into compression and to correct leg-length discrepancy. Material-Methods: Seven patients with non-united femoral neck fracture were treated by valgus osteotomy and free vascularized fibular graft. There were four males and three females, with a mean age of 27.2 years (16 to 39). Six of them sustained a femoral neck fracture in a motor vehicle accident and initially underwent fixation with Steinmann pins or cannulated screws. One sustained a pathologic fracture due to an aneurysmal bone cyst of the femoral head and neck. The mean delay between injury and reoperation was 8 months (range 2 – 16 months). All patients presented some degree of absorption of the femoral neck and avascular necrosis of the femoral head at various stages. To secure the osteotomy in its altered position, a 120 - 150 degrees blade-plate was used. The amount of valgus angulation varied from 20 degrees to 30 degrees. A derotation screw was placed proximal to the vascularized graft. Results: There were no intraoperative complications. One patient underwent a second operation (removal of the implants) 26 months after the osteotomy. Osseous union was achieved and there was clinical and radiological improvement of the avascular necrosis in all patients. Discussion: We recommend this procedure for the treatment of young adults with difficult intracapsular fractures of the femoral neck complicated with non-union, avascular necrosis, resorption of the neck and leg shortening.