Autologous bone cylinder transplantation with cannulated screw re-stabilisation: a new treatment option for delayed fracture healing of the femoral neck View Full Text


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Article Info

DATE

2011-07-31

AUTHORS

C. Frank, M. von Au, B. Vock, A. Wentzensen, P. A. Grützner, T. Guehring

ABSTRACT

AimDelayed fracture healing and non-unions of the femoral neck after lag screw osteosynthesis occur particularly in multiply injured young patients, and then surgical revision is often required. Currently no evidence-based treatment guidelines exist and therapeutic options include both hip arthroplasties and femoral head-maintaining operations. Here we report on young patients with delayed fracture healing of the femoral neck. Patients underwent revision surgery by autologous bone cylinder transplantation with mechanical re-stabilisation by cannulated lag screws.Material and methodsWe reviewed all patients after femoral neck screw osteosynthesis and identified eight patients at 7.3 [3–24] months after initial osteosynthesis with persisting, or reoccurring postoperative pain. Average patient age was 43 [35–57] years and patient Harris Hip Score (HHS) numbers were low (52 ± 19). Before revision surgery the preoperative CT scans showed a partial bone consolidation (anterior and/or posterior cortices) in the absence of a complete bone consolidation of all cortices. Seven patients were treated by bone cylinder transplantation from the patient’s own iliac crest; one patient underwent an inverse bone cylinder procedure. Seven patients were additionally treated by re-insertion of 1–2 lag screws to increase mechanical stability.ResultsAfter revision surgery the average patient follow-up period was 42 [12–89] months. Five patients achieved favourable clinical and radiographic outcome with both complete bone union and return to work within 7.2 ± 2.75 months. One patient showed fracture healing but developed an aseptic femoral head osteonecrosis. Two patients failed to achieve complete bone consolidation. The postoperative HHS was 92 ± 4 in patients with favourable clinical outcome (n = 5) and 89 ± 2 after second revision surgery (2 hip arthroplasties; 1 valgus osteotomy). Both groups had significantly better HHS numbers compared with before surgical revision (p < 0.05).Discussion These data show that in this difficult-to-treat subset of young patients with delayed fracture healing of the femoral neck, autologous bone cylinder transplantation with mechanical re-stabilisation should be considered as a promising surgical revision strategy before hip arthroplasty. More... »

PAGES

1509

References to SciGraph publications

  • 1996-09-01. Pseudarthrosen am proximalen Femur in DER ORTHOPÄDE
  • 2008-06-05. Behandlung der Schenkelhalsfrakturen in DER CHIRURG
  • 2009-12-10. Schenkelhalsfrakturen bei jüngeren Patienten (15–50 Jahre) in DER UNFALLCHIRURG
  • 1994-09. Ist die Remodellierung nach Kollaps bei Hüftkopfnekrose doch möglich? in EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00402-011-1344-z

    DOI

    http://dx.doi.org/10.1007/s00402-011-1344-z

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1036607757

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/21805361


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