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Introduction: Neck of femur fractures (NOF) in younger adults are often treated by head-preserving fixation procedures. Non-union is an infrequent but troublesome complication following internal fixation, especially in atypical presentations. Vascularized (VFG) and non-VFG (NVFG) fibular grafting and realignment procedures have been described as an adjunct to internal fixation. Reports are rare regarding the versatility of fibular grafts, their use, and their outcomes in the United Kingdom. Case Report: We present three complex NOF cases performed in the United Kingdom. One case is a 29-year-old Asian female treated with NVFG for a pathological transverse NOF fracture secondary to fibrous dysplasia. One case is a non-union following failed surgical management and revised using NVFG and dynamic hip screws. The last case is a VFG in a complex non-union intra-capsular fracture following conservative management in a 17-year-old male. Certain patient characteristics are described which make joint preserving surgery more attractive. All fractures united with no revisions at the time of final follow-up. Distinctions between the use of VFG and NVFG grafts are discussed. Conclusion: This case series demonstrates the important versatility of fibular grafting and how its properties are used in different cases. Fibular grafting is an effective technique in pathological, non-union, and late-presenting NOF. Both types of grafts introduce additional biology for difficult cases where neck resorption and adequate fixation are an issue, with NVFG grafts much easier to perform.
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INTRODUCTION: Non-autoimmune sacroiliac joint pain contributes to nearly a quarter of low back pain patients. Non-surgical management fails to satisfy patients. A new minimally invasive technique for sacroiliac stabilization has been introduced, defying the traditional rules of fusion. The results outside explanatory trials and in day-to-day practice have not been reported. MATERIALS AND METHODS: This case series includes 20 patients diagnosed with chronic sacroiliac pain resistant to conservative management for at least 6 months. The diagnosis was confirmed with a positive sacroiliac injection. Patients underwent stabilization using the iFuse® implant. Patients were followed up for a minimum of one year. The primary outcome was the functional outcomes, assessed using VAS, ODI, and SF36. Secondary procedure rates, complication rates, and radiological assessments of fusion were collected as secondary outcomes. RESULTS: At one year, the mean VAS score improved from 81.25 ± 10.7 SD preoperatively to 52.5 ± 26.8, p-value 0.0013. The mean ODI improved from 54.8 ± 11.21 SD preoperatively to 41.315 ± 15.34, P value = 0.0079. The mean PCS and MCS of SF36 improved by 17 and 20 points, respectively. Only 55% of patients achieved the MCID for the VAS score. 35% of the cohort had secondary procedures. DISCUSSION: Minimally invasive sacroiliac fusion resulted in an improvement in mean functional scores with a wide dispersion. Patients not achieving MCID are patients with either a malpositioned implant, an associated lumbar pathology, or an inaccurate diagnosis. Our results are underwhelming compared to similar work but are still better than conservative cohorts in comparative studies. CONCLUSION: Minimally invasive sacroiliac fusion can be used successfully in select patients. Attention to diagnosis and surgical technique can improve the reproducibility of results.
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CASE: A 26-year-old man presented with recurrent native hip dislocation after an initially traumatic posterior right hip dislocation. The combined soft-tissue and bony deficiency was addressed using an autologous bone block technique, as previously popularized for shoulder instability. Thirteen years postoperatively, no subsequent dislocations occurred, and the patient has an excellent functional outcome. CONCLUSION: The bone block technique for hip stabilization can be used to address focal acetabular deficiencies with promising long-term follow-up.
