Dynamic hip screw and fibular strut graft for fixation of fresh femoral neck fracture with posterior comminution.

INTRODUCTION: Posterior comminution of the femoral neck fracture is a major cause of delayed and non-union owing to the loss of the buttressing effect against the posterior rotation. When a femoral neck fracture with posterior comminution is anatomically reduced, only the anterior portions of the femoral neck fracture surfaces are brought into contact leaving a posterior defect. The purpose of this study was to evaluate the use of fibular strut grafting and dynamic hip screw (DHS) for fresh femoral neck fractures with posterior comminution in young patient less than 50 years. MATERIALS AND METHODS: Between October 2012 and March 2016, 35 patients aged 20-50 years, 30 men and 5 women underwent fixation using DHS and fibular strut grafts for Garden grades III (25 patients) and IV (10 patients) femoral neck fractures with posterior comminution. All fractures were reduced by closed methods, and no hip was aspirated. Clinical and radiological outcomes were evaluated. RESULTS: All patients were in the age group of 20-50 years (mean 37 years). The mean delay in presentation after injury was 1 day. The mean final follow-up for these 35 patients was 27.2 months. Healing of the femoral neck was attained in 34 cases, with an average time to union of 4.8 months (range 4-8 months). One patient underwent arthroplasty due to failure of fixation. According to the Harris hip score, outcome was good to excellent in 30 patients, fair in 4, and poor in 1. CONCLUSIONS: In our study, only one patient developed non-union and no patients had avascular necrosis of the femoral head. Closed reduction, fibular strut grafts, and DHS fixation is a reliable procedure for femoral neck fractures with posterior comminution in young adults.

Distraction osteogenesis in management of composite bone and soft tissue defects.

A soft tissue defect is one of the most difficult problems that may accompany bone defects. Plastic surgery is often required. During distraction osteogenesis, not only the bone but also the soft tissues are lengthened, which may help in spontaneous closure of the soft tissue defects. This study examines 11 cases of composite bone and soft tissue defects which were managed by distraction osteogenesis. After debridement of the necrotic tissues, the soft tissue defects ranged from three by four centimetres to five by 14 centimetres and the bone defects ranged from four to 12 centimetres. All the soft tissue defects healed during the process of bone transport without the need for plastic surgery, except in one case. The complications were successfully managed during the course of treatment. Distraction osteogenesis is a good method for simultaneous treatment of composite bone and soft tissue defects.