Artikel
Restoration of the collapsed femoral head in subchondral fatigue fracture of the femoral head
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Autoren
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Hee Joong Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea, Republic of (South Korea)
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Jeong Joon Yoo
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea, Republic of (South Korea)
| Veröffentlicht: | 23. Oktober 2017 |
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Gliederung
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Objectives: Subchondral fatigue fracture of the femoral head (SFFFH) is a rarely encountered condition. As in osteonecrosis of the femoral head, collapse of the femoral head can occur in SFFFH. If the fracture heals in the state of collapse, subsequent development of degenerative change would be inevitable. Therefore, it is expected that reconstruction of the sphericiy of the femoral head can improve the prognosis especially for markedly collapsed cases. In this study, the results of different surgical techniques to restore the collapsed femoral head were reviewed retrospectively to find out the most effective method.
Methods: Between February, 2001 and June, 2011, four cases of collapsed SFFFH were treated surgically to restore the sphericity of the femoral head. For each case, different surgical technique was tried. These include strut iliac crest autograft from the femoral neck (case 1), strut iliac crest autograft from the lateral cortex of the proximal femur (case 2), fibular allograft from the lateral cortex of the proximal femur (case 3) and impacted cancellous bone graft with fibular allograft from the lateral cortex of the proximal femur (case 4). The amounts of correction and recollapse were evaluated on the follow-up radiographs.
Results and Conclusion: All patient were male with age of 19~22 years. The collapse measured using concentric circles was 3.5mm in one (case 3) and 5.0mm in the other cases. Surgeries were performed between 15 and 49 days after the onset of the hip pain. Immediate postoperatively, the collapse was corrected almost completely in cases 1 and 3, minimally in case 2. In case 4, it was overcorrected. In all cases, the fracture was healed with some recollapse (1~1.5mm in cases 1, 2, and 3, and 4.5mm in case 4). On the last follow-up radiographs taken 4.5~8 years after surgery, some degenerative changes were observed but all patients had no remarkable limitation in daily activities.
In conclusion, strutting with allogenic fibular bone through a core tract from the lateral cortex of the proximal femur was the most simple and reliable method (Figure 1 [Fig. 1]).
