Modified Free Vascularized Fibular Grafting for the Treatment of Femoral Neck Nonunion

Objective: To evaluate a modified free vascularized fibular grafting procedure with an anterior approach to the hip as a treatment for femoral neck nonunions. Design: Retrospective radiographic and clinical review. Setting: Level I trauma center. Patients/Participants: Twenty-six femoral neck nonunions treated between November 2000 and December 2005. Main Outcome Measurements: Harris Hip scoring system and radiographic standard evaluation for bone union. Results: The average follow-up period was 29.3 months (range, 12-63 months). The average duration of the surgery was 2.5 hours (range, 2-4 hours). Average blood loss was 300 mL (range, 200―400 mL). The neck-shaft angle was improved by 2.3° on average. Twenty-four of 26 femoral neck nonunions healed without any severe complications. Average union time was 5.3 months (range, 3-9 months). Twenty-four patients had well-functioning hips with an average Harris hip score of 87.9 as compared with the average preoperative Harris hip score of 57.8. One case developed osteonecrosis of the femoral head requiring total hip arthroplasty 2 years after the index procedure. One case developed an immediate postoperative infection. Conclusion: The clinical result indicates that the anterior approach modification of free vascularized fibular grafting is a valuable procedure in the treatment of femoral neck nonunions.