Skip to main content
Top
Published in: International Orthopaedics 4/2016

01-04-2016 | Original Paper

Triple attack technique for non-union of femoral neck fractures

Authors: Hazem Abdelazeem, Ahmed Abdelazeem, Ahmed Al-Dars, Mohamed Hegazy, Nasef Abdellatif

Published in: International Orthopaedics | Issue 4/2016

Login to get access

Abstract

Purpose

The purpose of this study was to describe the technique and clinical results following the utilization of biomechanical and biological means for adequate fracture healing in management of non-union of the neck of femur while preventing distortion of normal hip biomechanics.

Methods

Twenty-two patients with non-united fractures of femoral neck in adults were treated with what was termed the 'triple attack' procedure. This constituted iliac autogenous bone grafting, valgus subtrochanteric osteotomy together with static fixation across the non-union fracture site of the neck to avoid delayed femoral neck shortening.

Results

All patients were classified as Pauwel’s type III fractures. The mean time interval between the last operation and the current procedure was 4.6 months. Average operative time was 58.6 minutes. Patients were followed up for an average of 43.6 months. Complete union was achieved in all cases at an average of 4.3 months. Significant improvement of all radiological parameters was noticed together with the Harris hip score from an average of 21.2 pre-operatively to 89.6 at the last follow-up.

Conclusion

The present study provides encouraging clinical and functional results to suggest that this newly described procedure (‘triple attack’) might be a valuable option in the management of non-united femoral neck fractures.
Literature
1.
go back to reference Damany DS, Parker MJ, Chojnowski A (2005) Complications after intracapsular hip fractures in young adults. A meta-analysis of 18 published studies involving 564 fractures. Injury 36:131–141PubMed Damany DS, Parker MJ, Chojnowski A (2005) Complications after intracapsular hip fractures in young adults. A meta-analysis of 18 published studies involving 564 fractures. Injury 36:131–141PubMed
2.
go back to reference Biber R, Brem M, Bail HJ (2014) Targon femoral neck for femoral-neck fracture fixation: lessons learnt from a series of one hundred and thirty five consecutive cases. Int Orthop 38(3):595–599CrossRefPubMedPubMedCentral Biber R, Brem M, Bail HJ (2014) Targon femoral neck for femoral-neck fracture fixation: lessons learnt from a series of one hundred and thirty five consecutive cases. Int Orthop 38(3):595–599CrossRefPubMedPubMedCentral
4.
go back to reference Kapoor A, Deety LV, John VZ et al (2012) Management of neglected femoral neck fractures and nonunions using a novel triple surgery combination: an Indian experience. Int J Low Extrem Wounds 11:49–58CrossRefPubMed Kapoor A, Deety LV, John VZ et al (2012) Management of neglected femoral neck fractures and nonunions using a novel triple surgery combination: an Indian experience. Int J Low Extrem Wounds 11:49–58CrossRefPubMed
5.
go back to reference Said GZ, Farouk O, Said HGZ (2010) Valgus intertrochanteric osteotomy with single-angled 130° plate fixation for fractures and non-unions of the femoral neck. Int Orthop 34:1291–1295CrossRefPubMedPubMedCentral Said GZ, Farouk O, Said HGZ (2010) Valgus intertrochanteric osteotomy with single-angled 130° plate fixation for fractures and non-unions of the femoral neck. Int Orthop 34:1291–1295CrossRefPubMedPubMedCentral
6.
go back to reference Kumar N, Kalra M (2013) Evaluation of valgus intertrochanteric osteotomy in neglected fracture neck femur in young adults. J Clin Orthop Trauma 4:53–57CrossRefPubMedPubMedCentral Kumar N, Kalra M (2013) Evaluation of valgus intertrochanteric osteotomy in neglected fracture neck femur in young adults. J Clin Orthop Trauma 4:53–57CrossRefPubMedPubMedCentral
7.
go back to reference Davidovitch RI, Jordan CJ, Egol KA, Vrahas MS (2010) Challenges in the treatment of femoral neck fractures in the nonelderly adult. J Trauma 68:236–242CrossRefPubMed Davidovitch RI, Jordan CJ, Egol KA, Vrahas MS (2010) Challenges in the treatment of femoral neck fractures in the nonelderly adult. J Trauma 68:236–242CrossRefPubMed
8.
go back to reference Sen RK, Tripathy SK, Goyal T, Aggarwal S, Tahasildar N, Singh D, Singh AK (2012) Osteosynthesis of femoral-neck nonunion with angle blade plate and autogenous fibular graft. Int Orthop 36(4):827–832CrossRefPubMedPubMedCentral Sen RK, Tripathy SK, Goyal T, Aggarwal S, Tahasildar N, Singh D, Singh AK (2012) Osteosynthesis of femoral-neck nonunion with angle blade plate and autogenous fibular graft. Int Orthop 36(4):827–832CrossRefPubMedPubMedCentral
9.
go back to reference Ficat RPAJ (1964) Forage-biopsie de la tete femorale dans l’osteonecrose primative. Observations histo-pathologiques portant sur huit forages. Rev Rhum 31:257–264 Ficat RPAJ (1964) Forage-biopsie de la tete femorale dans l’osteonecrose primative. Observations histo-pathologiques portant sur huit forages. Rev Rhum 31:257–264
10.
go back to reference Harris WH (1969) 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 51:737–755PubMed Harris WH (1969) 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 51:737–755PubMed
11.
go back to reference Elgafy H, Ebraheim NA, Bach HG (2011) Revision internal fixation and nonvascular fibular graft for femoral neck nonunion. J Trauma 70:169–173CrossRefPubMed Elgafy H, Ebraheim NA, Bach HG (2011) Revision internal fixation and nonvascular fibular graft for femoral neck nonunion. J Trauma 70:169–173CrossRefPubMed
12.
go back to reference Pauwels F (1935) Der Schenkelhalsbruch: Ein mechanisches problem. Stuttgart, Ferdinand Enke Verlag Pauwels F (1935) Der Schenkelhalsbruch: Ein mechanisches problem. Stuttgart, Ferdinand Enke Verlag
13.
go back to reference Raaymakers ELFB, Marti RK (2008) Nonunion of the femoral neck: possibilities and limitations of the various treatment modalities. Indian J Orthop 42:13–21CrossRefPubMedPubMedCentral Raaymakers ELFB, Marti RK (2008) Nonunion of the femoral neck: possibilities and limitations of the various treatment modalities. Indian J Orthop 42:13–21CrossRefPubMedPubMedCentral
14.
go back to reference Marti RK, Schüller HM, Raaymakers EL (1989) Intertrochanteric osteotomy for non-union of the femoral neck. J Bone Joint Surg (Br) 71:782–787 Marti RK, Schüller HM, Raaymakers EL (1989) Intertrochanteric osteotomy for non-union of the femoral neck. J Bone Joint Surg (Br) 71:782–787
15.
go back to reference Nagi ON, Dhillon MS, Goni VG (1998) Open reduction, internal fixation and fibular autografting for neglected fracture of the femoral neck. J Bone Joint Surg (Br) 80:798–804CrossRef Nagi ON, Dhillon MS, Goni VG (1998) Open reduction, internal fixation and fibular autografting for neglected fracture of the femoral neck. J Bone Joint Surg (Br) 80:798–804CrossRef
16.
go back to reference Hartford JM, Patel A, Powell J (2005) Intertrochanteric osteotomy using a dynamic hip screw for femoral neck nonunion. J Orthop Trauma 19:329–333CrossRefPubMed Hartford JM, Patel A, Powell J (2005) Intertrochanteric osteotomy using a dynamic hip screw for femoral neck nonunion. J Orthop Trauma 19:329–333CrossRefPubMed
Metadata
Title
Triple attack technique for non-union of femoral neck fractures
Authors
Hazem Abdelazeem
Ahmed Abdelazeem
Ahmed Al-Dars
Mohamed Hegazy
Nasef Abdellatif
Publication date
01-04-2016
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 4/2016
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-015-2808-5

Other articles of this Issue 4/2016

International Orthopaedics 4/2016 Go to the issue