Nonvascularized Fibular Grafting in Nonunion of Femoral Neck Fracture: A Systematic Review

Overview

Journal Indian J Orthop

Publisher Springer Nature

Specialty Orthopedics

Date 2016 Aug 12

PMID 27512214

Citations 7

Authors

Sujit Kumar Tripathy

Ramesh Kumar Sen

Tarun Goyal

Affiliations

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Abstract

Nonunion of femoral neck fractures following primary fixation and neglected femoral neck fracture in young adults is a challenging task. Every effort should be directed toward hip joint salvage in these patients. Among different available options of hip salvage, nonvascularized fibular graft (NVFG) osteosynthesis is simple, easy to perform, and a successful technique. In this review, the available literature on NVFG in neglected and nonunion femoral neck fractures has been analyzed. After review of 15 articles on NVFG, the average nonunion rate was estimated to be 7.86% (range 0-31%). Six articles that evaluated the preoperative and postoperative osteonecrosis reported improvement in 50% patients. The clinical and/or functional outcome was good to excellent in 56-96% patients following fibular osteosynthesis. Few complications such as coxa vara deformity, limb shortening, and intraarticular penetration of the graft or hardware have been reported. However, there are minimal donor site morbidities such as mild ankle pain, transient loss of toe flexors and extensors and transient lateral popliteal nerve palsy.

Citing Articles

Clinical Outcome of Free Vascularized Fibula Graft for Nonunion of Garden IV Femoral Neck Fracture of 13 Years Duration: A Case Report.

Zhang Y, Liu Y, Yan Q, Xiang Z Orthop Surg. 2022; 14(4):775-781.

PMID: 35352496 PMC: 9002078. DOI: 10.1111/os.13154.

[Effectiveness of triangular stabilization system for patients with postoperative nonunion of femoral neck fracture].

Li J, Chen H, Li J, Wang J, Yin P, Zhang L Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021; 35(7):795-800.

PMID: 34308583 PMC: 8311212. DOI: 10.7507/1002-1892.202012056.

The utility of the angled blade plate in hip fracture nonunion treatment: A report of three cases and review of the literature.

Lawrenz J, Marshall D, Patterson B OTA Int. 2021; 2(4):e041.

PMID: 33937669 PMC: 7997124. DOI: 10.1097/OI9.0000000000000041.

Comparative study of Pauwels type III femoral neck fractures managed by short dynamic hip screw with fibula bone graft or cannulated screws in young adults.

Li Z, Zhang X, Li Z, Peng A, Zhang L, Deng Y Ann Transl Med. 2020; 8(11):681.

PMID: 32617301 PMC: 7327311. DOI: 10.21037/atm-19-3344.

Treatment of femoral neck nonunion with a new fixation construct through the Watson-Jones approach.

Chen H, Li J, Chang Z, Liang X, Tang P J Orthop Translat. 2019; 19:126-132.

PMID: 31844620 PMC: 6896481. DOI: 10.1016/j.jot.2019.04.004.

References

Pal C, Kumar B, Dinkar K, Singh P, Kumar H, Goyal R . Fixation with cancellous screws and fibular strut grafts for neglected femoral neck fractures. J Orthop Surg (Hong Kong). 2014; 22(2):181-5. DOI: 10.1177/230949901402200213. View

Haidukewych G . Salvage of failed treatment of femoral neck fractures. Instr Course Lect. 2009; 58:83-90. View

Nagi O, Dhillon M, Goni V . Open reduction, internal fixation and fibular autografting for neglected fracture of the femoral neck. J Bone Joint Surg Br. 1998; 80(5):798-804. DOI: 10.1302/0301-620x.80b5.8703. View

Arnold W, Lyden J, Minkoff J . Treatment of intracapsular fractures of the femoral neck. With special reference to percutaneous Knowles pinning. J Bone Joint Surg Am. 1974; 56(2):254-62. View

Estrada L, Volgas D, Stannard J, Alonso J . Fixation failure in femoral neck fractures. Clin Orthop Relat Res. 2002; (399):110-8. DOI: 10.1097/00003086-200206000-00013. View

Tripathy S, Sen R, Goyal T . Reply to comment on Sen et al.: Osteosynthesis of femoral-neck nonunion with angled blade plate and autogenous fibular graft. Int Orthop. 2012; 36(6):1321-2. PMC: 3353072. DOI: 10.1007/s00264-012-1489-6. View

Elgafy H, Ebraheim N, Bach H . Revision internal fixation and nonvascular fibular graft for femoral neck nonunion. J Trauma. 2010; 70(1):169-73. DOI: 10.1097/TA.0b013e3181e5108b. View

BANKS H . Nonunion in fractures of the femoral neck. Orthop Clin North Am. 1974; 5(4):865-85. View

Nagi O, Gautam V, Marya S . Treatment of femoral neck fractures with a cancellous screw and fibular graft. J Bone Joint Surg Br. 1986; 68(3):387-91. DOI: 10.1302/0301-620X.68B3.3733802. View

10.

Kainth G, Yuvarajan P, Maini L, Kumar V . Neglected femoral neck fractures in adults. J Orthop Surg (Hong Kong). 2011; 19(1):13-7. DOI: 10.1177/230949901101900104. View

11.

Raaymakers E, Marti R . Nonunion of the femoral neck: possibilities and limitations of the various treatment modalities. Indian J Orthop. 2009; 42(1):13-21. PMC: 2759582. DOI: 10.4103/0019-5413.38575. View

12.

Gadegone W, Ramteke A, Lokhande V, Salphade Y . Valgus intertrochanteric osteotomy and fibular strut graft in the management of neglected femoral neck fracture. Injury. 2012; 44(6):763-8. DOI: 10.1016/j.injury.2012.09.014. View

13.

Azam M, Iraqi A, Sherwani M, Sabir A, Abbas M, Asif N . Free fibular strut graft in neglected femoral neck fractures in adult. Indian J Orthop. 2009; 43(1):62-6. PMC: 2739491. DOI: 10.4103/0019-5413.45325. View

14.

INCLAN A . Late complications in fracture of the neck of the femur treated by nailing, bone grafting or both. J Int Coll Surg. 2010; 9:36-50. View

15.

Chapman M, Stehr J, Eberle C, Bloom M, BOVILL Jr E . Treatment of intracapsular hip fractures by the Deyerle method. A comparative review of one hundred and nineteen cases. J Bone Joint Surg Am. 1975; 57(6):735-44. View

16.

Sandhu H, Sandhu P, Kapoor A . Neglected fractured neck of the femur: a predictive classification and treatment by osteosynthesis. Clin Orthop Relat Res. 2005; (431):14-20. View

17.

Roshan A, Ram S . Early return to function in young adults with neglected femoral neck fractures. Clin Orthop Relat Res. 2006; 447:152-7. DOI: 10.1097/01.blo.0000203483.13583.c8. View

18.

Jaiswal A, Pruthi K, Goyal R, Pathak V, Habib M, Tanwar Y . Evaluation of osteosynthesis with dual fibular bone grafting for neglected femoral neck fractures. J Clin Orthop Trauma. 2015; 4(2):58-69. PMC: 3880501. DOI: 10.1016/j.jcot.2013.04.003. View

19.

Sen R, Tripathy S, Goyal T, Aggarwal S, Tahasildar N, Singh D . Osteosynthesis of femoral-neck nonunion with angle blade plate and autogenous fibular graft. Int Orthop. 2011; 36(4):827-32. PMC: 3311820. DOI: 10.1007/s00264-011-1344-1. View

20.

Pauyo T, Drager J, Albers A, Harvey E . Management of femoral neck fractures in the young patient: A critical analysis review. World J Orthop. 2014; 5(3):204-17. PMC: 4095012. DOI: 10.5312/wjo.v5.i3.204. View