Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh 160012, India.
Int Orthop. 2012 Apr;36(4):827-32. doi: 10.1007/s00264-011-1344-1. Epub 2011 Sep 1.
Revision internal fixation for femoral-neck nonunion is a challenging procedure. Treatment options are osteotomy, osteosynthesis using various implants and grafting techniques (muscle pedicle, vascularised or nonvascularised fibular graft) or arthroplasty. The objective of this article is to report the outcome of revision internal fixation using an angle blade plate and autogenous fibular graft in symptomatic aseptic femoral-neck nonunion.
Twenty-two patients who had been treated previously with cannulated screws or dynamic hip screw for femoral-neck fracture and progressed to nonunion were treated with revision internal fixation using an angle blade plate and autogenous nonvascularised fibular graft. Mean patient age was 38 (range 21-52) years, with average duration between injury and revision surgery 11.2m (range 8-16 months).
Other than one nonunion, we achieved union in all patients (21 patients, 91%) after an average period of 4.4 months. The functional outcome after 3.2 years as per scoring system given by Nagi et al.. showed excellent results in four, good in ten, fair in six and poor in two patients. Patients with poor results included one with nonunion and other with avascular necrosis with collapse of the femoral head. Average limb shortening was 1.5 cm, and mean femoral-neck-shaft angle was 116°. There was no instance of fibular graft fracture, slippage or implant cut-through.
Angle blade plate provides rigid stability and offloads any shearing force over the fibular graft when used for revision internal fixation in aseptic femoral-neck nonunion. Thus, the fibular graft only serves the purpose of osteogenesis and stimulates the surrounding host cells to promote healing at the nonunion site. We recommend the angle blade plate and autogenous fibular graft as a viable option for hip-joint salvage in revision internal fixation of aseptic femoral-neck nonunion.
股骨颈骨不连的翻修内固定是一项具有挑战性的手术。治疗方案包括截骨术、使用各种植入物和植骨技术（肌蒂、带血管或不带血管腓骨移植）的骨合成以及关节置换术。本文的目的是报告使用角度钢板和自体腓骨移植治疗症状性无菌性股骨颈骨不连的结果。
22 例先前因股骨颈骨折接受空心螺钉或动力髋螺钉治疗后进展为骨不连的患者，采用角度钢板和自体非血管化腓骨移植进行翻修内固定治疗。患者平均年龄为 38 岁（范围 21-52 岁），受伤至翻修手术的平均时间为 11.2m（范围 8-16 个月）。
除 1 例骨不连外，所有患者（21 例，91%）在平均 4.4 个月后均实现了愈合。根据 Nagi 等人给出的评分系统，3.2 年后的功能结果显示，4 例为优秀，10 例为良好，6 例为一般，2 例为差。结果较差的患者包括 1 例骨不连，另 1 例发生股骨头缺血性坏死伴塌陷。平均肢体缩短 1.5cm，股骨颈干角平均为 116°。没有腓骨移植骨折、滑移或植入物穿透的情况。
在无菌性股骨颈骨不连的翻修内固定中，使用角度钢板可提供刚性稳定性，并减轻腓骨移植上的任何剪切力。因此，腓骨移植仅起到成骨作用，并刺激周围宿主细胞在骨不连部位促进愈合。我们建议将角度钢板和自体腓骨移植作为无菌性股骨颈骨不连翻修内固定中髋关节保存的可行选择。
