Bone grafting in femoral neck fractures: results in 28 cases operated on with multiple pinning and cancellous bone grafting.

Twenty-eight patients with displaced femoral neck fractures were operated on with multiple pinning combined with cancellous bone grafting from the ipsilateral greater trochanter. The bone graft was introduced through a drilled channel in the femoral neck without exposing the fracture. At follow-up after 2 years, seven patients had died. Two patients had been reoperated with prosthetic replacement of the hip. Nineteen fractures were united and one had developed segmental collapse. In femoral neck fractures, complications from non-union and segmental collapse are still a major problem. Even if the impaired vascular supply to the femoral head is responsible for most of the complications, anatomic reduction and a stable fixation are conductive to fracture union. Comminution of the posterior wall of the femoral neck has a negative influence on the security of fixation due to a persisting posterior gap after reduction. In previous reports, bone grafting of the posterior defect in the femoral neck through an open approach has achieved good results. Only a few studies, however, describe a technique of introducing bone chips through a drilled channel in the femoral neck. The use of the ipsilateral greater trochanter as the sole donor site for bone grafting in femoral neck fractures has not been reported previously.