Management of ununited intracapsular femoral neck fractures by using quadratus femoris muscle pedicle bone grafting in young patients

Abstract

Objectives: Intracapsular femoral neck fracture with delayed presentation in young patients can pose surgical challenge. Such scenarios are rare in developed countries, but common in developing countries. Methods: We retrospectively reviewed the records and radiographs of 42 patients (28 males and 14 females) with ununited intracapsular femoral neck fracture who presented late to our unit. These subjects were managed by open reduction and internal fixation that was supplemented with cortico-cancellous bone graft from posterior iliac crest as well as quadratus femoris muscle pedicle bone graft. Results: The mean delay in presentation was 9 months (range 3-18 months) after the fracture. The mean age of the patients at index procedure was 34 years (range 24-51 years). Radiological union occurred on average at 6 months (range 3-13 months). Thirty-six hip fractures (86%) proceeded to union. Six patients (14%) had non-union and needed revision surgery. Complications included varus union in 9 patients and leg length discrepancy with a mean of 1.5 cm (range 1 to 2.5 cm) in 10 patients. Conclusion: For the ununited intracapsular femoral neck fracture, favorable results can be achieved by anatomical reduction of the fracture, cortico-cancellous bone grafting to reconstruct the femoral neck, internal fixation with cancellous screws, and augmentation with quadratus femoris muscle pedicle bone graft.