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Autologous bone cylinder transplantation with cannulated screw re-stabilisation: a new treatment option for delayed fracture healing of the femoral neck

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Aim

Delayed fracture healing and non-unions of the femoral neck after lag screw osteosynthesis occur particularly in multiply injured young patients, and then surgical revision is often required. Currently no evidence-based treatment guidelines exist and therapeutic options include both hip arthroplasties and femoral head-maintaining operations. Here we report on young patients with delayed fracture healing of the femoral neck. Patients underwent revision surgery by autologous bone cylinder transplantation with mechanical re-stabilisation by cannulated lag screws.

Material and methods

We reviewed all patients after femoral neck screw osteosynthesis and identified eight patients at 7.3 [3–24] months after initial osteosynthesis with persisting, or reoccurring postoperative pain. Average patient age was 43 [35–57] years and patient Harris Hip Score (HHS) numbers were low (52 ± 19). Before revision surgery the preoperative CT scans showed a partial bone consolidation (anterior and/or posterior cortices) in the absence of a complete bone consolidation of all cortices. Seven patients were treated by bone cylinder transplantation from the patient’s own iliac crest; one patient underwent an inverse bone cylinder procedure. Seven patients were additionally treated by re-insertion of 1–2 lag screws to increase mechanical stability.

Results

After revision surgery the average patient follow-up period was 42 [12–89] months. Five patients achieved favourable clinical and radiographic outcome with both complete bone union and return to work within 7.2 ± 2.75 months. One patient showed fracture healing but developed an aseptic femoral head osteonecrosis. Two patients failed to achieve complete bone consolidation. The postoperative HHS was 92 ± 4 in patients with favourable clinical outcome (n = 5) and 89 ± 2 after second revision surgery (2 hip arthroplasties; 1 valgus osteotomy). Both groups had significantly better HHS numbers compared with before surgical revision (p < 0.05).

Discussion

These data show that in this difficult-to-treat subset of young patients with delayed fracture healing of the femoral neck, autologous bone cylinder transplantation with mechanical re-stabilisation should be considered as a promising surgical revision strategy before hip arthroplasty.

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Authors and Affiliations

  1. Klinik für Unfallchirurgie und Orthopädie, BG-Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany

    C. Frank, M. von Au, B. Vock, A. Wentzensen, P. A. Grützner & T. Guehring

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  1. C. Frank
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  2. M. von Au
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  3. B. Vock
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  4. A. Wentzensen
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  5. P. A. Grützner
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  6. T. Guehring
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Correspondence to T. Guehring.

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Frank, C., von Au, M., Vock, B. et al. Autologous bone cylinder transplantation with cannulated screw re-stabilisation: a new treatment option for delayed fracture healing of the femoral neck. Arch Orthop Trauma Surg 131, 1509–1518 (2011). https://doi.org/10.1007/s00402-011-1344-z

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