Autogenous fibula graft and cannulated screw fixation to cephalic cut out after DHS fixation: a retrospective study

Abstract

Background: This study aimed to explore the effect of the treatment through autologous fibula graft and hollow needle fixation to treat femoral head cutting after dynamic hip screw (DHS) fixation.

Methods: A total of 41 patients were admitted to the department of orthopedic trauma and received DHS fixation. Preoperative and postoperative harris score of hip function, limb shortening length and collodiaphysial angle between operation group (n = 11) and non-operation group (n = 13) were compared.

Results: There was no difference between the two groups before surgery (P > 0.05). There was a difference between the preoperative and postoperative in the operation group (P < 0.05). The excellent and good rate of the hip function score in patients 6 months after the operation was 55.6%. In the operation group, the hip function score increased after surgery (P < 0.001). Except for two groups of patients before operation, there was a difference in the limb shortening length and collodiaphysial angle between the operation group and non-operation group in other time points after surgery (P < 0.001).

Conclusion: The application of the autogenous fibula graft and hollow nail fixation was effective in treating femoral head cutting after DHS fixation, and patients' subjective evaluation and objective indicators' outcomes of follow up were satisfactory, which was worthy of clinical application.

Keywords: Atogenous fibula graft; Dynamic hip screw plate; Femoral head cutting; Intertrochanteric fracture.

Fig. 1

a DHS fixation of femoral intertrochanteric fracture failed. DHS screws appear cut and the nail tail protrudes from the femoral head. The length of the limb becomes shorten and the neck dry angle smaller. b Autogenous fibula graft and cannulated screw fixation to cephalic cut out after DHS Fixation. Fracture reduction will be performed after DHS is removed. Measure and correct the required fibula length to match the diameter of the remaining nail canal. c Femoral intertrochanteric fracture reduced again. Hip varus recovers well and the hollow nails are in a good position

Fig. 2

Patient, male, 68 years old, had a history of right femoral neck fracture with parallel femoral head replacement. a 1 day after the fall, he was admitted to the hospital. The left femur intertrochanteric fracture, the left lower extremity was shortened by 3 cm. b The left side DHS fixation was performed 5 days after admission, and the fracture reduction was slightly worse. c 142 days after DHS fixation, left hip varus deformity, limb shortening, DNS screw cutting, nail tail protruding femoral head

Fig. 3

Patient, male, 72 years old, left femoral intertrochanteric fracture, 109 days after DHS fixation. CT scan showed left hip varus deformity and limb shortening. DNS screw appeared to cut and nail tail protruded femoral head. a hip CT coronal position, b hip joint CT level

Fig. 4

One week after autologous iliac bone graft and cannulated screw fixation. The left hip varus was well reset and the position of the cannulated nail was good. The transplanted humerus (the hip X-ray anterior piece) was seen in the bone channel after the DNS screw was removed

Fig. 5

Three months after autologous iliac bone graft and cannulated screw fixation. The left hip varus was well restored, the position of the cannulated nail was good, the fracture line was blurred and the humeral bone shadow was observed. a hip X-ray anterior piece, b hip joint X-ray lateral slice

Fig. 6

Six months after autologous iliac bone graft plus cannulated screw fixation, left hip joint reduction, cannulated nail fixation, blurred fracture line, blurred humeral bone, and good fracture healing. a hip X-ray anterior piece, b hip joint X-ray lateral slice