A Complicated Stress Fracture of the Femoral Neck - A Case Report

AbstractA case is presented of a stress fracture of the femoral neck complicated by complete fracture. Additional complications arose when the repaired fracture went on to non-union due to bending of the DHS screw, requiring revision surgery with a valgus osteotomy. The case is important because this type of stress fracture has previously been considered to be safe from risk of complete fracture. The failure of the operative treatment has implications for young patients treated similarly.

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Role of Valgus Osteotomy and Fixation with Double Angle Blade Plate in the Management of Neglected and Ununited Femoral Neck Fracture

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/44597.15169 ◽

2021 ◽

Author(s):

Hari Om Aggarwal ◽

Amandeep Singh Bakshi ◽

Harjit K Singh Chawla ◽

Ayush Jain ◽

Jaspreet Singh

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Young Patients ◽

Valgus Osteotomy ◽

Non Union ◽

Neck Shaft Angle ◽

Blade Plate ◽

Neck Fracture ◽

Angle Blade ◽

Angle Blade Plate

Introduction: Femoral neck fracture non union in young patients is a challenging complication as joint replacement is not readily recommended and hip salvageable procedures are relatively unsatisfactory. Valgus intertrochanteric osteotomy described by Pauwels F is one of the treatment options for management of non union of femoral neck in young patients, which was later reciprocated by other surgeons. Aim: To assess the efficacy of valgus osteotomy and fixation with double angle blade plate in the management of neglected and ununited femoral neck fracture. Materials and Methods: This was a prospective cohort study, which included 30 patients of femoral neck fracture non union in whom intertrochanteric valgus osteotomy was performed and fixed with 120° double angled blade plate. The preoperative and postoperative neck-shaft angle was compared using the paired t-test. A p-value of <0.05 indicated statistically significant result. Results: There were 22 males (73.3%) and 8 females (26.7%). Mean age of patients was 35 years. Delay in presentation ranged from 8 weeks to 58 weeks (mean 24 weeks). By Pauwel’s classification, there were 13 Type II fractures and 17 Type III fractures. Mean follow- up was 18 months (12 to 36 months). The mean preoperative neck- shaft angle of 95° (range 80-110°) increased to 132° (range 120- 140°) after surgery. In all patients, there was improvement in leg length discrepancy after osteotomy. Femoral neck fractures united in 25 patients (83.3%). Conclusion: Valgus osteotomy and fixation with 120° double angle blade plate is a reliable method for treating non union femoral neck fracture in young adults. It provides rigid internal fixation and good results.

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Functional and radiological outcome of valgus osteotomy (abduction osteotomy of Pauwel) and fixation with dynamic hip screw in neglected fracture neck of femur

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20203504 ◽

2020 ◽

Vol 6 (5) ◽

pp. 920

Author(s):

Venugopal S. M. ◽

Naveen Babu ◽

Naresh Odnala ◽

Gudaru Jagadesh

Keyword(s):

Femoral Neck ◽

Young Patients ◽

Dynamic Hip Screw ◽

Harris Hip Score ◽

Osteotomy Site ◽

Valgus Osteotomy ◽

Neck Of Femur ◽

Non Union ◽

Fracture Neck Of Femur ◽

Hip Screw

Background: Despite improvements in the techniques of surgery and internal fixation devices, non-union is still reported in one-third of cases of femoral neck fracture with displacement. Valgus intertrochanteric osteotomy alters the biomechanical environment of the fracture site and restores limb length.Methods: This was a prospective study on functional outcome of valgus osteotomy and fixation with dynamic hip screw (DHS) in neglected fracture neck of femur in Balaji Institute of Surgery, Research and Rehabilitation for the Disabled (BIRRD), Tirupati. 28 patients were enrolled between December 2017 to December 2019. Patients less than 60 years of age with fracture neck of femur of more than or equal to 3 weeks since injury and with failed primary fixation were included. Patients >60 years of age, patients with avascular necrosis (AVN), and with resorption of femoral neck were excluded.Results: Among 28 patients 12 had union within 6 months and another 12 within 12 months. 4 patients were lost for follow-up hence considered as non-union. Osteotomy site united by 6 months in 22 patients and by 12 months in 2. Harris hip score was fair to excellent in 24 patients and poor in 4.Conclusions: Valgus osteotomy and DHS fixation is often a definitive one-time surgical procedure to achieve union in neglected and ununited fracture neck femur in young patients. It is simple and biological. In this study because of the delay in presentation and the young age of patients, Pauwels’ osteotomy was performed as the head-salvaging procedure. Union was achieved in 86% of this study patients.

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Femoral Neck Stress Fracture in Habitual Exercise Patient: A Case Report with Literature Reviews

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2020.09.11094 ◽

2020 ◽

Vol 103 (9) ◽

pp. 943-947

Keyword(s):

Case Report ◽

Femoral Neck ◽

Stress Fracture ◽

World Health ◽

Return To Sports ◽

Non Union ◽

Habitual Exercise ◽

In Situ Fixation ◽

Femoral Neck Stress Fracture ◽

Health Organization

Background: Femoral neck stress fracture (FNSF) is considered rare, and, as a consequence, is easily misdiagnosed due to a lack of awareness. The initial presentation can be subtle, but serious sequelae, including avascular necrosis of the femoral head or non-union could occur without proper management. Case Report: A left FNSF in a regularly exercising postmenopausal woman treated by in situ fixation with multiple cannulated screws is presented. Dual energy X-ray absorptiometry (DXA) scan revealed osteopenic bone marrow density (BMD) T-score. Subcutaneous denosumab injection was prescribed immediately following the operation according to World Health Organization (WHO) recommendation. Successful radiographic union was observed after three months without complications, and the patient was able to return to sports activities after six months. Conclusion: An early and accurate diagnosis of FNSF is essential in returning to sport and preventing undesirable harmful consequences. Keywords: Femoral neck, Stress fracture, Exercise, Athlete, Osteoporosis

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Nine-Year Functional Nonunion of a Femoral Neck Stress Fracture: Treatment With Internal Fixation and Fibular Graft: A Case Report

Orthopedics ◽

10.3928/0147-7447-19861101-12 ◽

1986 ◽

Vol 9 (11) ◽

pp. 1553-1557

Author(s):

Stephen J Snyder ◽

Orrin H Sherman ◽

Kurt Hattendorf

Keyword(s):

Case Report ◽

Femoral Neck ◽

Internal Fixation ◽

Stress Fracture ◽

Fibular Graft ◽

Fracture Treatment ◽

Femoral Neck Stress Fracture

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Case report: ischial stress fracture non-union in a college football player

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hny019 ◽

2018 ◽

Vol 5 (3) ◽

pp. 312-318 ◽

Cited By ~ 2

Author(s):

Adam C Shaner ◽

Andrea M Spiker ◽

Marci A Goolsby ◽

Bryan T Kelly ◽

David L Helfet

Keyword(s):

Case Report ◽

Stress Fracture ◽

Football Player ◽

College Football ◽

Non Union

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Locking Plate Fixation System for Intracapsular Fracture Neck of Femur in Young Patients

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0014.7565 ◽

2021 ◽

Vol 23 (1) ◽

pp. 27-32

Author(s):

Islam Mubark ◽

Mahmoud Nafady ◽

Bahaa A. Motawea

Keyword(s):

Femoral Head ◽

Femoral Neck ◽

Hip Replacement ◽

Locking Plate ◽

Plate Fixation ◽

Young Patients ◽

Locking Plate Fixation ◽

Non Union ◽

Mean Time ◽

Fixation System

Background. Intra-capsular fractures of the femoral neck in young patients are almost always treated with surgical fixation to preserve the native hip anatomy and biomechanics. Multiple Cannulated hip screws and the sliding hip screw have been the hallmark fixation devices for these injuries. The use of locking cannulated hip screws to a side plate was developed to mitigate the biological and mechanical downfalls of these devices. To report the outcome following the use of a locking plate fixation system in the management of intracapsular fractures of the femoral neck in young patients. Material and methods. A case series study of all the patients treated in our institution between 2014 and 2017. All eligible patients with hip intracapsular fractures aged between 18 and 65 were treated with a proximal locking hip plate system. The main reported outcomes were union rate, failure of fixation, and development of avascular necrosis of the femoral head. Results: Fifty-six patients (36 men and 20 women) at a mean age of 39.1 years (range 20-65 years) completed 24 months’ follow-up. Mean time to surgery was 16 hours. No intraoperative complications were reported. The mean time to union was 15.9 weeks (range 12-23). Three patients (5.3%, one Garden type III, and two type IV) did not achieve union at 6 months. Two patients had revision surgery with valgus osteotomy and the third patient required total hip replacement because of screw penetration. Five patients (8.9%) developed avascular necrosis of the femoral head (2 patients Garden type III, and 3 patients Garden VI). Only two patients required conversion to total hip replacement. Conclusions. 1. The results in this study showed lower rates of non-union, AVN and secondary operation as compared to published data on both SCH and DHS. 2. It also compares favorably with results reported for dynamic locking screw systems. 3. The study had few limitations, including lack of comparative groups. Also, when considering fracture classification subgroups, the unstable fracture pattern had higher rates of non-union and AVN. 4. This calls for a further larger number of studies dedicated to these fracture categories to ascertain long-term outcome with this type of fixation.

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