Modified free vascularized fibular grafting for the treatment of femoral neck nonunion.

OBJECTIVE: To evaluate a modified free vascularized fibular grafting procedure with an anterior approach to the hip as a treatment for femoral neck nonunions. DESIGN: Retrospective radiographic and clinical review. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Twenty-six femoral neck nonunions treated between November 2000 and December 2005. MAIN OUTCOME MEASUREMENTS: Harris Hip scoring system and radiographic standard evaluation for bone union. RESULTS: The average follow-up period was 29.3 months (range, 12-63 months). The average duration of the surgery was 2.5 hours (range, 2-4 hours). Average blood loss was 300 mL (range, 200-400 mL). The neck-shaft angle was improved by 2.3 degrees on average. Twenty-four of 26 femoral neck nonunions healed without any severe complications. Average union time was 5.3 months (range, 3-9 months). Twenty-four patients had well-functioning hips with an average Harris hip score of 87.9 as compared with the average preoperative Harris hip score of 57.8. One case developed osteonecrosis of the femoral head requiring total hip arthroplasty 2 years after the index procedure. One case developed an immediate postoperative infection. CONCLUSION: The clinical result indicates that the anterior approach modification of free vascularized fibular grafting is a valuable procedure in the treatment of femoral neck nonunions.

Treatment of old femoral neck and nonunion with free vascularized fibular grafting / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical result of the treatment of old femoral neck fracture and nonunion with free vascularized fibular grafting.</p><p><b>METHODS</b>From November 2000 to December 2005, 29 cases with old femoral neck fracture and nonunion had been treated by free vascularized fibular grafting with an average follow-up of 28.5 months.</p><p><b>RESULTS</b>All the fracture were healed without any severe complications. And the healing time was 4-6 months (5.6 months on average). During the follow-up, the hips of 28 cases got well-function, and the average Harris hip score was 88.2. One case came about with osteonecrosis of femoral head after one year and finally accepted THA after 2 years.</p><p><b>CONCLUSIONS</b>The free vascularized fibular grafting is a valuable procedure to treat old femoral neck fracture and nonunion.</p>

The surgical technique and follow-up of the treatment with locking internal fixation on long bone nonunion of extremities / 中华外科杂志

<p><b>OBJECTIVE</b>To report the outcome of long bone nonunion of humerus, femur and tibia treated with locking internal fixation and bone graft.</p><p><b>METHODS</b>From February 2003 to October 2006, locking internal fixation and bone grafting were employed to treat 5 cases at humerus, 33 cases at femur, 23 cases at tibia. Forty-four of the patients were men, and 17 were women. The mean age was 38 years (range 7-70 years). The nonunion had resulted from failure of internal fixation in 47 cases, failure of external fixation in 5 cases, infection in 9 cases. The history of nonunion lasted from 10 to 156 months (mean 19 months). There were 42 patients treated with locking compression plate (LCP), and 19 patients with less invasive stabilization system (LISS). For bone grafting, autogenous ilium was used in 55 patients, autogenous ilium and allograft bone was used in 3 patients, allograft bone and Wright DBM artificial bone was used in 3 patients.</p><p><b>RESULTS</b>All the 61 patients were followed up for an average 12 months (range 6-24 months) only to reveal solid bone union in all the fracture, with a mean healing time of 4.8 months (ranged from 4 to 6 months). No loosening or breakage of the implants occurred in this series. The Knee Society Scores (KSS) was used to evaluate knee function in 47 patients with peri-knee joint nonunion, excellent result were seen in 35 patients, good in 7 patients, fare in 1 patients, poor in 4 patients.</p><p><b>CONCLUSION</b>Locking internal fixation can be used to treat effectively bone nonunion at the humerus, femur and tibia.</p>