Free Fibular Strut Graft In Femoral Neck Fractures at
Sanglah General Hospital Denpasar I Ketut Sumadi* Cok Gde Oka Darmayuda**
*Resident of Orthopedic and Traumatology Department, Sanglah General Hospital, Udayana University, Bali ** Staff of Orthopedic and Traumatology Department, Sanglah General Hospital, Udayana University Bali
Introduction
Femoral neck fracture in adults still poses a formidable challenge. Existing treatment options varies from osteotomy (with or without graft) to osteosynthesis using various implants and grafting techniques (muscle pedicle, vascularized, and nonvascularized fibula). There is no consensus regarding the treatment of neglected fractures of neck of femur in younger population. Most agree that an attempt should be made to salvage the head.
Case
Female, 16 yo, diagnosed with closed fracture left neck femur basical type and open fracture left intercondyler femur, Male, 17 years old, diagnosed with Neglected Fracture Left Collum Femur and performed open reduction and internal fixation with canulated screw and free fibuar strut graft with good reduction and stable fixation.
Discussion
Treatment of femoral neck fracture still remains an "unsolved problem", specially for young, active adults where preservation of femoral head is desired. For active young adult, replacement arthroplasty is not indicated because of long, active productive life ahead. free fibular cortical graft provides mechanical support and fixation, have satisfactory osteoconductive and inductive potential, prevents subchondral fracture and collapse of head femur.
Conclusion
Nonvascularized fibular strut graft along with cancellous screws provides a dependable and technically less-demanding alternative. We recommend its use to salvage the femoral head in younger patients. Fibula being cortical provides mechanical strength besides stimulating union and getting incorporated as biological graft.
