Pseudarthrosis of Femoral Neck Stress Fracture Treated with Open Reduction, Sliding Hip Screw and Bone Morphogenic Protein

Overview

Journal Int J Surg Case Rep

Specialty General Surgery

Date 2012 Aug 18

PMID 22898259

Citations 1

Authors

D Dargan

D McCaffrey

W D C Kealey

Affiliations

Soon will be listed here.

Abstract

Introduction: Pseudarthrosis of femoral neck stress fractures in young adults are associated with a high incidence of complications and revision surgery. The majority are treated urgently with closed reduction and internal fixation.

Presentation Of Case: We describe a displaced tension-type femoral neck fatigue fracture presenting late. Pseudarthrosis formation prior to surgery resulted in resorption and shortening of the femoral neck. Open reduction and internal fixation was performed, with adjuvant recombinant human bone morphogenic protein-7 therapy. Radiological union was achieved by twelve weeks and by one year the patient was asymptomatic.

Discussion: Reports of successful management of femoral neck fatigue fracture non-unions are rare. Meyer's muscle pedicle graft, valgus subtrochanteric osteotomy, and cannulated screw fixation with autologous iliac crest bone graftare alternative procedures.

Conclusion: This extremely rare fracture type merits open reduction to enable accurate fracture reduction. Supplementing sliding hip screw fixation with an orthobiological agent was successful in this challenging situation.

Citing Articles

Bilateral pseudarthrosis of the femoral neck in a 25-year-old male with hereditary hypophosphatemic rickets.

Anthonissen J, Ossendorf C, Vetter T, Habermann B, Rommens P Case Rep Orthop. 2014; 2014:312712.

PMID: 24955267 PMC: 4052474. DOI: 10.1155/2014/312712.

References

Fullerton Jr L, Snowdy H . Femoral neck stress fractures. Am J Sports Med. 1988; 16(4):365-77. DOI: 10.1177/036354658801600411. View

Meurman K, ELFVING S . Stress fracture in soldiers: a multifocal bone disorder. A comparative radiological and scintigraphic study. Radiology. 1980; 134(2):483-7. DOI: 10.1148/radiology.134.2.7352236. View

Pihlajamaki H, Ruohola J, Kiuru M, Visuri T . Displaced femoral neck fatigue fractures in military recruits. J Bone Joint Surg Am. 2006; 88(9):1989-97. DOI: 10.2106/JBJS.E.00505. View

Marti R, Schuller H, Raaymakers E . Intertrochanteric osteotomy for non-union of the femoral neck. J Bone Joint Surg Br. 1989; 71(5):782-7. DOI: 10.1302/0301-620X.71B5.2584247. View

Daffner R, Pavlov H . Stress fractures: current concepts. AJR Am J Roentgenol. 1992; 159(2):245-52. DOI: 10.2214/ajr.159.2.1632335. View

Jones B, Thacker S, Gilchrist J, Kimsey Jr C, Sosin D . Prevention of lower extremity stress fractures in athletes and soldiers: a systematic review. Epidemiol Rev. 2003; 24(2):228-47. DOI: 10.1093/epirev/mxf011. View

Shin A, Morin W, Gorman J, Jones S, Lapinsky A . The superiority of magnetic resonance imaging in differentiating the cause of hip pain in endurance athletes. Am J Sports Med. 1996; 24(2):168-76. DOI: 10.1177/036354659602400209. View

Diwanji S, Kong I, Cho S, Seon J, Yoon T . Displaced stress fracture of the femoral neck treated by valgus subtrochanteric osteotomy: 2 case studies. Am J Sports Med. 2007; 35(9):1567-70. DOI: 10.1177/0363546507299241. View

Harris W . Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969; 51(4):737-55. View

10.

Lee C, Huang G, Chao K, Jean J, Wu S . Surgical treatment of displaced stress fractures of the femoral neck in military recruits: a report of 42 cases. Arch Orthop Trauma Surg. 2003; 123(10):527-33. DOI: 10.1007/s00402-003-0579-8. View

11.

Haddad F, Bann S, Hill R, Jones D . Displaced stress fracture of the femoral neck in an active amenorrhoeic adolescent. Br J Sports Med. 1997; 31(1):70-2. PMC: 1332481. DOI: 10.1136/bjsm.31.1.70. View

12.

Kiuru M, Pihlajamaki H, Ahovuo J . Fatigue stress injuries of the pelvic bones and proximal femur: evaluation with MR imaging. Eur Radiol. 2003; 13(3):605-11. DOI: 10.1007/s00330-002-1562-4. View

13.

Garrison K, Shemilt I, Donell S, Ryder J, Mugford M, Harvey I . Bone morphogenetic protein (BMP) for fracture healing in adults. Cochrane Database Syst Rev. 2010; (6):CD006950. PMC: 6669254. DOI: 10.1002/14651858.CD006950.pub2. View

14.

Sen M, Miclau T . Autologous iliac crest bone graft: should it still be the gold standard for treating nonunions?. Injury. 2007; 38 Suppl 1:S75-80. DOI: 10.1016/j.injury.2007.02.012. View

15.

Mendez A, Eyster R . Displaced nonunion stress fracture of the femoral neck treated with internal fixation and bone graft. A case report and review of the literature. Am J Sports Med. 1992; 20(2):230-3. DOI: 10.1177/036354659202000226. View

16.

Pihlajamaki H, Ruohola J, Weckstrom M, Kiuru M, Visuri T . Long-term outcome of undisplaced fatigue fractures of the femoral neck in young male adults. J Bone Joint Surg Br. 2006; 88(12):1574-9. DOI: 10.1302/0301-620X.88B12.17996. View

17.

Wu C, Shih C, Chen W, Tai C . Treatment of femoral neck nonunions with a sliding compression screw: comparison with and without subtrochanteric valgus osteotomy. J Trauma. 1999; 46(2):312-7. DOI: 10.1097/00005373-199902000-00019. View

18.

LeCroy C, Rizzo M, Gunneson E, Urbaniak J . Free vascularized fibular bone grafting in the management of femoral neck nonunion in patients younger than fifty years. J Orthop Trauma. 2002; 16(7):464-72. DOI: 10.1097/00005131-200208000-00004. View

19.

Datir A . Stress-related bone injuries with emphasis on MRI. Clin Radiol. 2007; 62(9):828-36. DOI: 10.1016/j.crad.2007.02.018. View

20.

Aro H, Dahlstrom S . Conservative management of distraction-type stress fractures of the femoral neck. J Bone Joint Surg Br. 1986; 68(1):65-7. DOI: 10.1302/0301-620X.68B1.3941143. View