Fixation of Fresh Femoral Neck Fractures Using Fibular Strut Graft Along with Cannulated Screws.

Background: Intracapsular femoral neck fractures can result from trivial trauma in the elderly or high-energy trauma in younger age-groups. In younger patients aged <60 years, the femoral head should be conserved to avoid the long-term complications of replacement arthroplasty. The options of osteosynthesis include closed/ open reduction and internal fixation with/without bone grafting. Internal fixation alone does not provide rigid fixation, owing to cavities in the posterior part of the femoral head and neck. Fibular grafts augment union and provide strength to the posterior cortex during reconstruction of the femoral neck. We evaluated the use of fibular grafting for fresh femoral neck fractures with posterior comminution.

Material and methods: Between November 2019 and March 2022, 20 women and 12 men aged 20 to 60 years underwent osteosynthesis and fibular strut grafting supplemented with 7.0-mm cannulated hip screws for Garden grades III (n=19) and IV (n=13) femoral neck fractures. Clinical and radiological outcomes were evaluated.

Results: Patients were followed up for a period of 15 months. According to the Harris hip score, outcome was good to excellent in 23, fair in 7, and poor in 2. 30 of the 32 patients achieved bone union after a mean of 4.5 (range 3.5-5.5) months. In 2 patients, the bone was united with a mean of 10º of varus collapse. Two patients had non-union. Other complications included screw migration in the joint space (n=1) and screw pullout (n=2). No patient had avascular necrosis of the femoral head.

Conclusion: Fixation with cancellous screws and fibular strut grafts for femoral neck fractures is cost-effective and technically less demanding, and associated with good outcomes.