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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_II | Pages 2 - 2
1 Feb 2012
Sayana M Vallamshetla V Nath V Murthy V
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Fracture neck of femur with delayed presentation in young patients can be a surgical challenge. Such scenarios are rare in the developed world but not uncommon in developing countries.

To present the medium term results of open reduction and internal fixation accompanied by Quadratus Femoris muscle pedicle grafting in young patients who presented with a delay after sustaining a fracture neck of femur, 42 patients with fracture neck of femur with delayed presentation were treated with open reduction and internal fixation and supplemented with Quadratus Femoris muscle pedicle graft. A posterior approach was used in all cases. The patients were advised not to bear weight until there was clinical and radiological union. Functional recovery was assessed by gait and ability to squat on the floor.

The age of the patients, predominantly male, ranged from 24 yrs to 50 yrs. Radiological union occurred on average at 6 months. Thirty-six patients proceeded to union; six patients had non-union and needed revision surgery. Complications included varus union in 9 cases; shortening greater than 2 cms occurred in 6 cases.

Quadratus Femoris muscle pedicle grafting described by Meyer in the 1970s is useful in treating fracture neck of femur. Open reduction and internal fixation of the fracture neck of femur when supplemented with Quadratus Femoris muscle pedicle graft fixation promoted the union of fracture and preserved the head the femur.


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_I | Pages 166 - 167
1 Mar 2006
Sayana MK Vallamshetla V Ravindranath V Murthy V
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Background: Fracture neck of femur with delayed presentation in young patients can be surgical challenge to any Orthopaedic surgeon. Such scenarios are rare in developed world, but are not uncommon in developing countries.

Aim: To present the medium term results of open reduction and internal fixation accompanied by Quadratus femoris muscle pedicle grafting in young patients who presented at least 3 months after sustaining a fracture neck of femur

Materials and Methods: 42 patients with ununited fracture neck of femur with delayed presentation were treated with open reduction and internal fixation and supplemented with Quadratus Femoris muscle pedicle graft. With patient in lateral position, posterior approach was used in all cases. The patients were advised not bear weight till there was clinical and radiological union. Functional recovery was assessed by gait and ability to squat on the floor.

Results: The delay in presentation ranged from 3 months to 1year after sustaining the intracapsular fracture. The age of the patients ranged from 24 yrs to 50 yrs. There was male predominance. Radiological union occurred on average at 6 months. 36 patients proceeded to union. 6 patients had non-union and needed revision surgery. Complications included varus union in 9 cases, shortening greater than 2.5 cms in 6 cases.

Conclusion: The two staged technique described by Meyer was modified into a single stage open reduction and internal fixation of the fracture neck of femur with quadratus femoris muscle pedicle graft fixation. This helped in promoting the union of the fracture and also preserve the head of the femur (avoiding arthroplasty).