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Re: Несросшийся перелом шейки бедра
послал Simon Gortz 27 Март 2002, 15:27
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I think THR is not a desirable outcome for a patient this young without trying a fixation first unless the AVN leads to a complete collapse. Consider intertrochanteric valgus osteotomy, which leads to healing of the femoral neck nonunion in a high percentage of cases (less than 90 percent).
Existence of AVN in femoral head does not prevent nonunion healing and may not compromise result.
Craig needle biopsy to rule out infection as a cause for the non-union and electrical stimulation may be indicated. Please see references below.
Best wishes,
Simon Gortz,
stud. med. Uni Duesseldorf
a.. Anglen, JO: Femoral Neck and Shaft Fracture. A case study. University of Missouri, 1999
a.. Anglen, JO: Intertrochanteric osteotomy for failed internal fixation of femoral neck fracture. Clin Orthop 341:175-182, 1997
a.. Askin SR, Bryan RS: Femoral neck fractures in young adults. Clin Orthop 1976 Jan-Feb; (114):
259-64
a.. Baksi, DP: Internal fixation of ununited femoral neck fracture combined with muscle-pedicle bone grafting. JBJS 68B:239-245, 1986
a.. Ballmer FT, Ballmer PM, Baumgaertl F, Ganz R, Mast JW: Pauwels osteotomy for nonunions of the femoral neck. Orthop Clin N Am 21:759-67, 1990
a.. Bray TJ, Smith-Hoefer E, Hooper A, Timmerman L: The displaced femoral neck fracture. Internal fixation versus bipolar endoprosthesis. Results of a prospective, randomized comparison. Clin Orthop
1988 May; (230): 127-40
a.. Hartford, JM, Patel AC: Intertrochanteric Osteotomy with Dynamic Compression for Femoral Neck Nonunion. Poster Presentation AAOS Convention, 2002
a.. Lifeso R, Younge D: The neglected hip fracture. J. Orthop Trauma 4:287-92, 1990
a.. Marti RK, Schuller HM, Raaymakers ELFB: Intertrochanteric osteotomy for nonunion of the femoral neck. JBJS 71B782-7, 1989
a.. Waddell JP, Schemitsch EH, McKee, MD, Morton, J: Management of Femoral Neck Non-unions. Podium Presentation AAOS Convention, 2002
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