Femoral Neck Non-union Treated using Compression Screw with or without Gluteus Medius Trochanteric Flap: A Case Series of Ten patients
https://doi.org/10.5704/MOJ.2111.023
- Author:
Faisham WI
1
;
Munajat I
1
;
Salim AA
1
Author Information
1. Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
- Publication Type:Journal Article
- Keywords:
femoral neck non-union, femoral neck fracture, trochanteric flap, myo-osseous flap, sliding compression screw
- From:Malaysian Orthopaedic Journal
2021;15(No.3):137-142
- CountryMalaysia
- Language:English
-
Abstract:
Non-union is a challenging complication following a femoral
neck fracture. Inability to achieve anatomical reduction and
compression over the fracture leads to non-union. We
reported a 10-case series of femoral neck non-union treated
with sliding compression screw and anti-rotational screw
with or without gluteus medius local trochanteric flap. When
compression could not be achieved and a gap was present
over the non-union site, a gluteus medius trochanteric flap
was used to enhance the union. Surgeries were performed as
a single-stage procedure through the Watson Jones approach.
The initial implants were removed, followed by fracture
reduction, during which the varus deformity was corrected,
and the neck length was preserved as much as possible.
Patients were advised for strict non-weight bearing until the
presence of trabecular bone crossing the fracture on the
radiographs. Union was achieved at three months in all
cases. Patients undergoing surgery without trochanteric flap
had normal abduction strength, and the neck length was
maintained. All cases had no significant loss of function.
Patients with trochanteric myo-osseous flap had neck
shortening with weak abductors with MRC grade 4. Two out
of 10 cases developed avascular necrosis of the femoral head
before intervention. One case progressed to collapse of the
femoral head requiring implant removal. This and the
femoral neck shortening, caused this patient to have weak
abductors and a positive Trendelenburg gait. We observed
that delayed surgery leads to neck shortening and fracture
gap requiring trochanteric myo-osseous flap to achieve
union.
- Full text:16.2021my12151.pdf
