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Endosteal biologic augmentation for surgical fixation of displaced femoral neck fractures


Lazaro, Lionel E; Birnbaum, Jacqueline F; Farshad-Amacker, Nadja A; Helfet, David L; Potter, Hollis G; Lorich, Dean G (2016). Endosteal biologic augmentation for surgical fixation of displaced femoral neck fractures. Journal of Orthopaedic Trauma, 30(2):81-88.

Abstract

Objectives: To report outcomes of a cohort with displaced Femoral Neck Fractures (FNF) treated with a length/angle-stable construct augmented with an endosteal fibular allograft serving as a biologic dowel.
Design: Prospective
Setting: Level I Trauma Center
Patients: The study group consists of twenty-seven patients with isolated FNF surgically treated by a single surgeon.
Intervention: Open reduction of the femoral neck, fixed with a length- and angle stable-construct of two fully threated cannulated screws augmented with an endosteal fibular allograft serving as a biologic dowel.
Main Outcome Measurements: Clinical and radiographic outcomes of the fixation construct and the viability of both the femoral head and the fibular allograft, host response to the allograft and osseous union was evaluated using a specialized sequence of contrast-enhanced MRI obtained at 3 and 12 months postoperatively.
Results: This construct resulted in high union rates (89%; 24/27). Two patients suffered early catastrophic failure and one patient developed fracture non-union, all of wish underwent uneventful conversion to total hip arthroplasty. Three (11%) additional patients had removal of symptomatic implants. The clinical and radiographic outcomes were excellent. Twelve months MRIs revealed either partial or complete osseous incorporation of 86% the fibular allografts without signs of adverse reaction of the host to the allograft. Femoral head osteonecrosis segments were noted in 76% of patients on MRI, however radiographically there were no sign of osteonecrosis or segmental collapse.
Conclusion: The fibular allograft reconstructs the comminuted femoral neck, and the osteointegration overtime increases the strength of the host-bone-graft interface. This added strength seems to provide the stability needed to better preserve the intra-operative reduction, obtain good outcomes and reduce the complications associated with FNF.
Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Abstract

Objectives: To report outcomes of a cohort with displaced Femoral Neck Fractures (FNF) treated with a length/angle-stable construct augmented with an endosteal fibular allograft serving as a biologic dowel.
Design: Prospective
Setting: Level I Trauma Center
Patients: The study group consists of twenty-seven patients with isolated FNF surgically treated by a single surgeon.
Intervention: Open reduction of the femoral neck, fixed with a length- and angle stable-construct of two fully threated cannulated screws augmented with an endosteal fibular allograft serving as a biologic dowel.
Main Outcome Measurements: Clinical and radiographic outcomes of the fixation construct and the viability of both the femoral head and the fibular allograft, host response to the allograft and osseous union was evaluated using a specialized sequence of contrast-enhanced MRI obtained at 3 and 12 months postoperatively.
Results: This construct resulted in high union rates (89%; 24/27). Two patients suffered early catastrophic failure and one patient developed fracture non-union, all of wish underwent uneventful conversion to total hip arthroplasty. Three (11%) additional patients had removal of symptomatic implants. The clinical and radiographic outcomes were excellent. Twelve months MRIs revealed either partial or complete osseous incorporation of 86% the fibular allografts without signs of adverse reaction of the host to the allograft. Femoral head osteonecrosis segments were noted in 76% of patients on MRI, however radiographically there were no sign of osteonecrosis or segmental collapse.
Conclusion: The fibular allograft reconstructs the comminuted femoral neck, and the osteointegration overtime increases the strength of the host-bone-graft interface. This added strength seems to provide the stability needed to better preserve the intra-operative reduction, obtain good outcomes and reduce the complications associated with FNF.
Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2016
Deposited On:18 Jan 2016 16:13
Last Modified:08 Dec 2017 17:02
Publisher:Lippincott Williams & Wilkins
ISSN:0890-5339
Additional Information:This is a non-final version of an article published in final form in Journal of Orthopaedic Trauma.
Publisher DOI:https://doi.org/10.1097/BOT.0000000000000452
PubMed ID:26817574

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