Treatment of old femoral neck fracture in adults with sartorius pedicle iliac bone flap and proximal femoral locking plate / 中国组织工程研究

ABSTRACT

BACKGROUND: The fracture of femoral neck in adults is very common. Most of them can be cured by operation or conservative treatment, but a few can develop into old fracture. At present, there is no clear and effective treatment for old fracture of femoral neck in adults. OBJECTIVE: To explore the clinical effect of sartorius pedicle iliac bone flap combined with proximal femoral locking plate in the treatment of old femoral neck fracture in adults. METHODS: Twelve adult patients with old femoral neck fracture were treated with sartorius pedicle iliac bone flap combined with proximal femoral locking plate, 9 males and 3 females, aged 18-47 years, with an average age of 33. 5 years. Garden classification: Type I in 0 cases, type II in 1 case, type III in 7 cases, and type IV in 4 cases. All of them were incised by Smith Petersen (S-P) approach. The 2/3 sartorius pedicle iliac bone flap of the anterior superior iliac spine was chiseled with a bone knife, about 4. 0 cm×1. 0 cm×1. 0 cm in size. After reduction, the proximal femur was fixed with steel plate and screw. Finally, the sartorius pedicle iliac bone flap was implanted into the defect of the femoral neck and fixed. At 3, 6, 12, and 24 months after the operation, X-ray films were reexamined to evaluate the fracture healing and Harris score of hip joint was used to evaluate the recovery of hip joint function. RESULTS AND CONCLUSION: (1) Twelve patients were followed up for at least 24 months. (2) Harris scores of hip were significantly higher at 3, 6, 12, and 24 months after surgery (54. 4±6. 4, 68. 7±6. 8, 82. 3±4. 2, 90. 3±4. 6) than those before surgery (46. 3±6. 1) (P < 0. 05). (3) There were no complications, such as wound nonunion, infection, or venous thrombosis. Finally, 11 patients finally achieved bony healing at the fracture site. One patient had nonunion at 28 months postoperatively with avascular necrosis of the femoral head (ARCO stage IV), followed by artificial hip replacement. Harris score before operation was 38, and Harris score at 3 months postoperatively was 98. (4) The results show that the combination of sartorius pedicle iliac bone flap and proximal femoral locking plate is a good method for the treatment of old femoral neck fracture in adults, with high healing rate and low necrosis rate of femoral head.