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. 2017;11(1):28-35.
doi: 10.1302/1863-2548-11-160221.

Fibular strut graft for nonunited femoral neck fractures in children

A Elgeidi  1 , A El-Negery  1
Affiliations

Fibular strut graft for nonunited femoral neck fractures in children

A Elgeidi et al. J Child Orthop. 2017.

Abstract

Purpose: To evaluate the clinical and radiological outcomes of using fibular strut grafts as a fixation device for non-united femoral neck fractures in children with or without subtrochanteric valgus osteotomy.

Methods: A total of 12 children with non-united femoral neck fractures (nine males and three females) with an average age of 8.2 years (5 to 12) were managed, and functional results evaluated, between July 2013 and July 2015. The mechanisms of injury were fall from a height in ten patients and road traffic accident in two cases. Nine cases of femoral neck nonunion followed failed internal fixation and three cases were neglected fractures. Six cases were treated by fibular strut graft and subtrochanteric valgus osteotomy with contoured plate and six cases were treated by fibular strut graft and hip spica.

Results: The mean follow-up period was 20.4 months (12 to 36). Union was achieved in all 12 cases by a mean of 3.5 months (2.5 to 6). All patients were satisfied at five months. For final analysis of clinical and radiographic results, the Ratliff's classification was used. We classed 11 cases as good results and one case as fair.

Conclusions: Fibular strut grafts are a reliable option for treatment of pseudo-arthrosis in femoral neck fracture nonunion in children. It is successful in restoration of femoral neck length in children with non-united femoral neck fractures.

Keywords: femoral neck fractures; fibular strut graft; hip spica; nonunion; subtrochanteric osteotomy.

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Figures

Fig. 1
Fig. 1
Nonunited femoral neck fracture with neck-shaft angle less than 110°.
Fig. 2
Fig. 2
Fibular strut grafts with subtrochanteric valgus osteotomy.
Fig. 3
Fig. 3
Nonunited femoral neck fracture with neck-shaft angle greater than 110°.
Fig. 4
Fig. 4
Fibular strut grafts without subtrochanteric valgus osteotomy (anteroposterior view).
Fig. 5
Fig. 5
Fibular strut grafts without subtrochanteric valgus osteotomy (lateral view).
Fig. 6
Fig. 6
Guide wire inserted in the center of the femoral neck.
Fig. 7
Fig. 7
Reaming over the guide wire using the distal part of the triple reamer of dynamic hip screw.
Fig. 8
Fig. 8
Graft impacted over the guidewire to a subphyseal position.
Fig. 9
Fig. 9
Final position of the fracture and the graft into the femoral neck (anteroposterior view).
Fig. 10
Fig. 10
Final position of the fracture and the graft into the femoral neck (lateral view).
See this image and copyright information in PMC

References

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