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Fracture of the femoral neck in younger adults. A new method of treatment for delayed and nonunions.

Femoral neck fractures in young patients present a special problem because ischemic necrosis of the femoral head frequently follows. Total hip arthroplasty is not recommended because of the young age, but other methods of treatment are controversial. The best approach is prevention of the development of ischemic necrosis when treatment is delayed or has failed. Although introduction of blood supply into the ischemic femoral head has been attempted using muscle pedicled bone struts, the results have not been encouraging. A new technique using a vascularized pedicled bone strut across the fracture site, on top of the usual screw fixation, was applied to 15 cases. Fracture union occurred in all cases. After a five- to seven-year follow-up time, technical failure occurred in one case and ischemic necrosis in another. Otherwise, functional and radiographic results were satisfactory. In high-risk cases of fracture neck of femur among young adults, screw fixation combined with vascularized bone strut bridging is the recommended treatment.