Osteosynthesis of femoral-neck nonunion with angle blade plate and autogenous fibular graft.

PURPOSE: 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.

METHODS: 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).

RESULTS: 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.

CONCLUSION: 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.