We evaluated the outcome of treatment of nonunion
of an intracapsular fracture of the femoral neck in young patients
using two cannulated screws and a vascularised bone graft. A total
of 32 patients (15 women and 17 men, with a mean age of 36.5 years;
20 to 50) with failed internal fixation of an intracapsular fracture
were included in the study. Following removal of the primary fixation,
two cannulated compression screws were inserted with a vascularised
iliac crest bone graft based on the ascending branch of the lateral
femoral circumflex artery. At a mean follow-up of 6.8 years (4 to 10), union was achieved
in 27 hips (84%). A total of five patients with a mean age of 40.5
years (35 to 50) had a persistent nonunion and underwent total hip
arthroplasty as also did two patients whose fracture united but
who developed osteonecrosis of the femoral head two years post-operatively. Statistical
analysis showed that younger patients achieved earlier and more
reliable union (p <
0.001). The functional outcome, as assessed
by the Harris Hip score, was better in patients aged <
45 years
compared with those aged >
45 years (p <
0.001). These findings suggest that further fixation using two cannulated
compression screws and a vascularised iliac crest bone graft is
an effective salvage treatment in patients aged <
45 years, in
whom osteosynthesis of a displaced intracapsular fractures of the
femoral neck has failed. Cite this article:
