Treatment of Garden Ⅲ and Ⅳ fractures of the femoral neck in young adults with vascularized bone flap graft / 中华显微外科杂志

ABSTRACT

Objective To compare open reduction and cannulated screws combined with ascending branch of lateral femoral circumflex artery iliac bone flap with closed reduction and cannulated screw fixation for the treatment of displaced femoral neck fracture in young adults.Methods From January 1992 to January 2007,totally 204 cases of displaced femoral neck fracture were treated.Group Aone hundred and three cases were treated with open reduction and 2 cannulated screw fixation,covered by the vascular pedicled iliac bone flap with ascending branch of lateral femoral circumflex artery.Garden classificationtype Ⅲ.68 cases,type Ⅳ35 cases.Group Bone hundred and one cases,treated with closed reduction and three cannulated screw fixation.Garden classificationtype Ⅲ in 62 cases and type Ⅳ in 39 cases.Results Two groups were followed up for 5-15 years.The healing time of group A was (73 ±21.2) days,including 4 cases of nonunion fracture (3.9％) and 5 cases of femoral head avascular necrosis occurred (4.9％) ; The healing time of group B was (89 ± 12.5) days,including 12 cases of nonunion fracture (11.9％) and 18 cases of femoral head avascular necrosis occurred (17.8％).The healing time,the rate of nonunion of fracture and the rate of femoral head necrosis were significantly different of these 2 groups.Conclusion The treatment of open reduction and 2 cannulated screw fixation,covered by the vascular pedicled iliac bone flap with ascending branch in young adults can effectively prevent nonunion of fractures and osteonecrosis of the femoral head.