Revision Internal Fixation and Nonvascular Fibular Graft for Femoral Neck Nonunion

Background: The rates of nonunion after internal fixation for femoral neck fractures have been reported to range from 0% to 59%. Existing treatment options are osteotomy (with or without graft), osteosynthesis using various implants and grafting techniques (muscle pedicle, vascularized, and nonvascularized fibula), or arthroplasty. The objective of this study was to assess the outcome results of revision internal fixation and nonvascular fibular bone grafting for symptomatic aseptic femoral neck nonunion. Methods: This is a retrospective case series study involving 17 patients with symptomatic femoral neck nonunion that were treated with revision internal fixation and fibular bone graft. The inclusion criteria were aseptic symptomatic femoral neck nonunion with no or minimal varus alignment. There were eight men and nine women. The average age was 46 years (range, 24-58 years). Thirteen patients had autogenous fibular bone graft, and six patients had fibular allograft. Results: Of the 13 patients who had autogenous nonvascularized fibular bone grafts, four remained in nonunion. Fibular autograft had a 69.2% success rate with the mean time to union 4.8 months. Four of the six patients who had fibular allografts remained in nonunion. Fibular allograft had a 33.3% success rate with the mean time to union 13.3 months. Conclusion: This study showed that revision internal fixation and fibular autograft have resulted into a better and faster union rate than fibular allografts.