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      Sartorius muscle pedicle iliac bone graft for treating neglected femoral neck fracture: A case series

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          Abstract

          Introduction

          Femoral neck fractures in patients less than 50 years account for less than 5 % of all hip fractures. Controversy remains regarding timing of surgery, operative technique, and optimal implant construct because of a lack of prospective clinical trials. The blood supply to the femoral head is tenuous and easily injured in the setting of displaced fractures. An alternative using sartorius muscle pedicle iliac bone graft has not been discussed widely.

          Case presentation

          Four patients with neglected femoral neck fracture were included in the series; all underwent cannulated screws fixation and osteomuscular pedicled graft using sartorius muscle. All patients achieved bone healing after 6-months of follow-up.

          Conclusion

          Our series demonstrate that sartorius muscle pedicle graft may be a good choice for treating neglected femoral neck fractures. Further studies are required to investigate its outcome and complications.

          Highlights

          • There is controversy regarding controversy remains regarding timing of surgery, operative technique, and optimal implant construct because of a lack of prospective clinical trials in the treatment of femoral neck fractures in the adult population.

          • The blood supply to the femoral head is tenuous and easily injured in the setting of displaced fractures.

          • An alternative using sartorius muscle pedicle iliac bone graft has not been discussed widely.

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          Most cited references12

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          The PROCESS 2020 Guideline: Updating Consensus Preferred Reporting Of CasE Series in Surgery (PROCESS) Guidelines

          The PROCESS Guidelines were first published in 2016 and were last updated in 2018. They provide a structure for reporting surgical case series in order to increase reporting robustness and transparency, and are used and endorsed by authors, journal editors and reviewers alike. In order to drive forwards reporting quality, they must be kept up to date. As such, we have updated these guidelines via a DELPHI consensus exercise.
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            Results of internal fixation of Pauwels type-3 vertical femoral neck fractures.

            It has been postulated that femoral neck fractures with a more vertical fracture line (i.e., a high Pauwels angle) may experience more shear forces and therefore may be predisposed to nonunion or loss of fixation. Although there is controversy regarding which fixation method is ideal, we are aware of no large clinical series in which the treatment outcomes of these fractures were evaluated. The purpose of this multicenter study was to evaluate a large consecutive series of high shear angle (>70 degrees) femoral neck fractures to learn more about the outcomes, complications, and performance of various internal fixation strategies. Between January 1993 and January 2005, seventy-six Pauwels type-3 (Orthopaedic Trauma Association [OTA] type-31B2.3) femoral neck fractures were treated in seventy-five patients with a mean age of forty-two years. Fourteen patients were lost to follow-up. Sixty-two fractures in sixty-one patients were followed to union or revision surgery, with a mean duration of follow-up of twenty-four months. Thirty-seven fractures were treated with cannulated screws and twenty-five, with a fixed-angle device. The reduction quality, accuracy of implant placement, time to surgery, influence of capsular decompression, and rates of nonunion and osteonecrosis were evaluated. Fifty-nine (95%) of the fractures had good-to-excellent reduction, and three had a fair reduction. There was a nonunion of eight (14%) of the fifty-nine fractures with a good-to-excellent reduction and two of the three with a fair reduction. There was a septic nonunion of one fracture treated with a dynamic hip screw. There was an aseptic nonunion of seven (19%) of the thirty-seven fractures treated with screw fixation alone as compared with two (8%) of the twenty-five fractures treated with a fixed-angle device. Osteonecrosis occurred after treatment of seven (11%) of the sixty-two fractures. Despite timely, excellent reduction and accurate implant placement in the vast majority of cases, the nonunion rate was 19% for fractures treated with cannulated screws alone and 8% for those treated with a fixed-angle device. Although these failure rates are not significantly different, we believe that this study documents the challenging nature of this fracture pattern and the ideal fixation device remains undefined.
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              Femoral-neck fractures in young adults.

              Twenty-two young adult patients with femoral-neck fractures fitting the following criteria were evaluated. All patients (1) were between twenty and forty years old, (2) had clinical and follow-up roentgenograms at least twelve months after the injury, (3) incurred fracture of the neck of the femur through normal bone, and (4) did not incur a stress fracture. The incidence of non-union was 59 per cent (thirteen of twenty-two patients) and of avascular necrosis, 86 per cent (nineteen of twenty-two patients). Evaluation of patients and results are discussed.
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                Author and article information

                Contributors
                Journal
                Int J Surg Case Rep
                Int J Surg Case Rep
                International Journal of Surgery Case Reports
                Elsevier
                2210-2612
                16 June 2023
                August 2023
                16 June 2023
                : 109
                : 108410
                Affiliations
                [a ]Department of Orthopaedics and Traumatology, Soeradji Tirtonegoro Hospital, Klaten, Indonesia
                [b ]Department of Orthopaedics and Traumatology, Siaga Medika Hospital, Banyumas, Central Java, Indonesia
                [c ]Department of Orthopaedics and Traumatology, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
                [d ]Faculty of Medicine, Public Health of Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
                Author notes
                [* ]Corresponding author at: Department of Orthopaedics and Traumatology, Soeradji Tirtonegoro Hospital, Klaten Faculty of Medicine, Public Health of Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia doktergustomrhatomy@ 123456yahoo.com
                Article
                S2210-2612(23)00539-4 108410
                10.1016/j.ijscr.2023.108410
                10362283
                a2d8fc7c-407a-4ecd-850a-4d3d30107de9
                © 2023 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 14 October 2022
                : 7 June 2023
                : 8 June 2023
                Categories
                Case Series

                sartorius muscle pedicle iliac bone graft,neglected femoral neck fracture

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