Cannulated Screw Fixation Augmented With Autogenous Iliac Bone Grafting In Treatment Of Displaced Femoral Neck Fractures In Young Adults

Objective: To introduce a new technique for the treatment of displaced femoral neck fractures in young adults.Closed reduction and inverted triangular cannulated screws fixation combined with autogenous iliac bone grafting was used to treat displaced femoral neck fractures in young adults,and compared it with traditional cannulated screw fixation to verify its efficacy.Methods: 65 patients with displaced femoral neck fracture treated with closed reduction and internal fixation in the third Hospital of Hebei Medical University from March 2014 to January 2018 were retrospectively analyzed.According to the treatment methods,the patients were divided into two groups: group A and group B.29 patients in group A were fixed with inverted triangle cannulated screws combined with autogenous iliac bone grafting,and 36 in group B were fixed with traditional screws.The baseline data,operation time,intraoperative blood loss,fracture reduction quality,fracture healing time,Harris hip score and the incidence of complications were recorded and compared between the two groups.Results: Due to the additional bone grafting procedure,the operation time in group A(67.6±5.9min)was significantly longer than that in group B(59.5±8.4min,P < 0.001).There was no significant difference in intraoperative blood loss and fracture reduction quality between group A(89.0±20.4ml;Garden index grade 1=19,grade 2=10)and group B(81.6±14.1ml;Garden index grade 1=21,grade 2=15)(P1=0.091,P2=0.554).The fracture healing time in group A(15.5±3.9 weeks)was significantly shorter than that in group B(18.2±3.8 weeks,P=0.008).There was no nonunion in group A and 3 cases in group B,but the difference was not statistically significant(P=0.111).Avascular necrosis of the femoral head occurred in 1 case in group A,which was significantly less than that in group B(n=8,P=0.029).The Harris hip score in group A(88.4±5.5)was significantly higher than that in group B(82.5±8.6,P=0.002).Conclusions: Closed reduction and three cannulated screws fixation augmented with autogenous iliac bone grafting is a reliable procedure for displaced FNF in young adults.This technique is minimally invasive and easy to operate,which can reduce the incidence of nonunion and avascular necrosis of the femoral head.