Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China.
Department of Orthopedics, People's Fourth Hospital of Sichuan Province, Chengdu, China.
Orthop Surg. 2022 Apr;14(4):775-781. doi: 10.1111/os.13154. Epub 2022 Mar 29.
Femoral neck fractures in young patients are mostly caused by high-energy trauma and demonstrate more displacement and vertical fracture surfaces, which increase nonunion and osteonecrosis risks. Free vascularized fibula graft (FVFG) is effective in treating old femoral neck fractures and nonunion; however, available data are limited to patients within 2 years after injury or revision surgery. We present the case of a patient who was diagnosed with femoral neck fracture at the age 9 and treated with FVFG 13 years later.
A 9-year-old Asian girl who experienced left hip pain after an injury was diagnosed with Garden IV left femoral neck fracture, which was treated through manipulation reduction and fixed with splints. At age 16, the pain worsened after another injury and was considered to be in the physical development stage. She refused surgical treatment; hence, the fracture was fixed externally with splints. At age 22, she was hospitalized owing to a 12-day left hip pain with restricted movement caused by a fall. She was diagnosed with old Garden IV femoral neck fracture nonunion and treated with FVFG. Seven years postoperatively, imaging showed that the left femoral neck was internally fixed, the fracture had healed, and the Harris score was 90 points. The 36-Item Short Form Health Survey responses revealed that the patient's physiological functioning, emotional well-being, energy, and mental health were normal. She achieved satisfactory functional results and resumed her normal daily life.
FVFG could provide satisfactory outcomes for long-term old femoral neck fractures.
年轻患者的股骨颈骨折多由高能创伤引起，表现为更多的移位和垂直骨折面，这增加了骨不连和骨坏死的风险。游离腓骨血管化移植（FVFG）在治疗陈旧性股骨颈骨折和骨不连方面是有效的；然而，现有数据仅限于受伤后 2 年内或翻修手术后的患者。我们报告了一例患者，该患者在 9 岁时被诊断为股骨颈骨折，13 年后接受了 FVFG 治疗。
一名 9 岁的亚洲女孩在受伤后出现左髋部疼痛，被诊断为左股骨颈 Garden IV 型骨折，采用手法复位和夹板固定进行治疗。16 岁时，她在另一次受伤后疼痛加剧，被认为处于身体发育阶段。她拒绝手术治疗；因此，骨折用夹板外部固定。22 岁时，她因跌倒后左髋部疼痛 12 天伴活动受限而住院。她被诊断为陈旧性 Garden IV 型股骨颈骨折骨不连，并接受了 FVFG 治疗。术后 7 年，影像学显示左股骨颈内固定，骨折愈合，Harris 评分为 90 分。36 项简短健康调查问卷的回答显示，患者的生理功能、情绪健康、精力和心理健康均正常。她获得了满意的功能结果并恢复了正常的日常生活。
FVFG 可为长期陈旧性股骨颈骨折提供满意的结果。
