PEDICLED ILIAC PERIOSTEAL FLAP GRAFT FOR AVASCULAR NECROSIS OF FEMORAL HEAD AFTER FEMORAL NECK FRACTURE IN ADOLESCENTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WUMin ,  GUANJianzhong , XIAOYuzhou , ZHOUJiansheng , ZHANGChangchun , DAIXiusong , WANGXiaopan , WANGZhaodong

Department of Orthopedics, the First Affiliated Hospital of Bengbu Medical College, Laboratory of Tissue and Transplant in Anhui Province, Bengbu Anhui, 233003, P. R. China;

Corresponding author：

GUANJianzhong, Email: jzguan2002@163.com

Keywords：

Femoral neck fracture; Avascular necrosis of femoral head; Vascular periosteal flap; Adolescent

DOI：

10.7507/1002-1892.20150059

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Objective To assess the effectiveness of pedicled iliac periosteal flap graft for treatment of avascular necrosis of the femoral head (ANFH) after femoral neck fracture in adolescents. Methods Between December 2006 and August 2011, 9 patients (9 hips) with ANFH after femoral neck fracture were treated with pedicled iliac periosteal flap graft. There were 6 males and 3 females with an average age of 14.7 years (range, 10-18 years). Fractures were caused by traffic accident injury (5 cases), falling injury from height (3 cases), and fall injury (1 case). The time from injury to internal fixation with Kirschner wires or cannulated screws was 3-16 days, and all fractures healed within 10 months after internal fixation. The interval between fracture fixation and ANFH was 10-42 months (mean, 24.4 months). According to Steinberg staging system, 1 hip was classified as stage Ⅲb, 2 hips as stage Ⅲc, 1 hip as stage IVa, 3 hips as stage IVb, and 2 hips as stage IVc. The Harris scores and Steinberg classification were compared between at pre- and post-operation to assess the outcomes clinically and radiologically. Results All incisions healed by first intention. No complications of infection, deep venous thrombosis of lower limb, and pain and numbness of donor site were observed during or after operation. All patients were followed up 38-76 months (mean, 52 months). Joint pain was relieved; no leg length discrepancy was observed; the walking gait was improved and range of motion of hips was increased. The Harris score was significantly increased from 62.8±3.6 at pre-operation to 92.7±9.9 at last follow-up, showing significant difference (t=-12.244, P=0.000). The hip function was excellent in 5 hips, good in 3 hips, and poor in 1 hip, and the excellent and good rate was 88.89%. Post-operative radiological assessment demonstrated that only 1 hip (stage Ⅲb) had further collapse of the femoral head, the other hips had no incidence of deterioration. The radiological success rate was 88.89% (8/9). Conclusion The pedicled iliac periosteal flap graft for ANFH after femoral neck fracture in adolescents can provide good osteogenesis and vascular reconstruction of the femoral head.

Citation： WUMin, GUANJianzhong, XIAOYuzhou, ZHOUJiansheng, ZHANGChangchun, DAIXiusong, WANGXiaopan, WANGZhaodong. PEDICLED ILIAC PERIOSTEAL FLAP GRAFT FOR AVASCULAR NECROSIS OF FEMORAL HEAD AFTER FEMORAL NECK FRACTURE IN ADOLESCENTS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(3): 275-279. doi: 10.7507/1002-1892.20150059 Copy

1.	Bartoníček J, Vávra J, Bartoška R, et al. Operative treatment of avascular necrosis of the femoral head after proximal femur fractures in adolescents. Int Orthop, 2012, 36(1):149-157.
2.	Morsy HA. Complications of fracture of the neck of the femur in children. A long-term follow-up study. Injury, 2001, 32(1):45-51.
3.	Bali K, Sudesh P, Patel S, et al. Pediatric femoral neck fractures:our 10 years of experience. Clin Orthop Surg, 2011, 3(4):302-308.
4.	Azam MQ, Iraqi A, Sherwani M, et al. Delayed fixation of displaced type Ⅱ and Ⅲ pediatric femoral neck fractures. Indian J Orthop, 2009, 43(3):253-258.
5.	Maeda S, Kita A, Fujii G, et al. Avascular necrosis associated with fractures of the femoral neck in children:histological evaluation of core biopsies of the femoral head. Injury, 2003, 34(4):283-286.
6.	Zhao D, Xu D, Wang W, et al. Iliac graft vascularization for femoral head osteonecrosis. Clin Orthop Relat Res, 2006, 442:171-179.
7.	Civinini R, De Biase P, Carulli C, et al. The use of an injectable calcium sulphate/calcium phosphate bioceramic in the treatment of osteonecrosis of the femoral head. Int Orthop, 2012, 36(8):1583-1588.
8.	Quinlan WR, Brady PG, Regan BF. Fracture of the neck of the femur in childhood. Injury, 1980, 11(3):242-247.
9.	王亦璁. 骨与关节损伤. 4版. 北京:人民卫生出版社, 2007:1153.
10.	Kujat R, Suren EG, Rogge D, et al. Femoral neck fractures during the growth period. Treatment principles, results, prognosis. Chirurg, 1984, 55(1):43-48.
11.	Hajdu S, Oberleitner G, Schwendenwein E, et al. Fractures of the head and neck of the femur in children:an outcome study. Int Orthop, 2011, 35(6):883-888.
12.	Assouline-Dayan Y, Chang C, Greenspan A, et al. Pathogenesis and natural history of osteonecrosis. Semin Arthritis Rheum, 2002, 32(2):94-124.
13.	Zhang CQ, Sun Y, Chen SB, et al. Free vascularised fibular graft for post-traumatic osteonecrosis of the femoral head in teenage patients. J Bone Joint Surg (Br), 2011, 93(10):1314-1319.
14.	Hughes LO, Beaty JH. Fractures of the head and neck of the femur in children. J Bone Joint Surg (Am), 1994, 76(2):283-292.
15.	Abbas AA, Yoon TR, Lee JH, et al. Posttraumatic avascular necrosis of the femoral head in teenagers treated by a modified transtrochanteric rotational osteotomy:a report of three cases. J Orthop Trauma, 2008, 22(1):63-69.
16.	Zhao G, Yamamoto T, Ikemura S, et al. Radiological outcome analysis of transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head at a mean follow-up of 12.4 years. J Bone Joint Surg (Br), 2010, 92(6):781-786.
17.	Bachiller FG, Caballer AP, Portal LF. Avascular necrosis of the femoral head after femoral neck fracture. Clin Orthop Relat Res, 2002, (399):87-109.
18.	Gopinathan NR, Chouhan D, Akkina N, et al. Case report:Bilateral femoral neck fractures in a child and a rare complication of slipped capital epiphysis after internal fixation. Clin Orthop Relat Res, 2012, 470(10):2941-2945.
19.	王本杰, 赵德伟, 郭林, 等. 带血管蒂髂骨瓣移位治疗股骨颈骨折术后股骨头缺血性坏死. 中国修复重建外科杂志, 2011, 25(5):526-529.
20.	朱金强, 沈柏晓, 杨文峰. 带旋髂深血管蒂髂骨及髂骨膜瓣移位治疗中青年股骨颈骨折. 中国修复重建外科杂志, 2009, 23(5):631-632.
21.	梁涛. 带旋髂深血管蒂髂骨骨膜移位修复股骨头缺血性坏死. 中国修复重建外科杂志, 2002, 16(1):73.
22.	官建中, 周建生, 肖玉周, 等. 带血管蒂骨膜瓣移植治疗幼犬股骨头坏死实验研究. 中华显微外科杂志, 2010, 33(3):217-220.
23.	Huang GK, Liu ZZ, Shen YL, et al. Microvascular free transfer of iliac bone based on the deep circumflex iliac vessels. J Microsurg, 1980, 2(2):113-120.
24.	黄恭康. 带血管髂骨移植的十年应用经验. 修复重建外科杂志, 1991, 5(2):73-76.
25.	Fuchs B, Knothe U, Hertel R, et al. Femoral osteotomy and iliac graft vascularization for femoral head osteonecrosis. Clin Orthop Relat Res, 2003, (412):84-93.
26.	肖玉周, 周建生, 刘振华, 等. 带旋髂深血管骨膜瓣移植治疗儿童股骨头缺血性坏死. 中华显微外科杂志, 2005, 28(1):24-25.

1. Bartoníček J, Vávra J, Bartoška R, et al. Operative treatment of avascular necrosis of the femoral head after proximal femur fractures in adolescents. Int Orthop, 2012, 36(1):149-157.
2. Morsy HA. Complications of fracture of the neck of the femur in children. A long-term follow-up study. Injury, 2001, 32(1):45-51.
3. Bali K, Sudesh P, Patel S, et al. Pediatric femoral neck fractures:our 10 years of experience. Clin Orthop Surg, 2011, 3(4):302-308.
4. Azam MQ, Iraqi A, Sherwani M, et al. Delayed fixation of displaced type Ⅱ and Ⅲ pediatric femoral neck fractures. Indian J Orthop, 2009, 43(3):253-258.
5. Maeda S, Kita A, Fujii G, et al. Avascular necrosis associated with fractures of the femoral neck in children:histological evaluation of core biopsies of the femoral head. Injury, 2003, 34(4):283-286.
6. Zhao D, Xu D, Wang W, et al. Iliac graft vascularization for femoral head osteonecrosis. Clin Orthop Relat Res, 2006, 442:171-179.
7. Civinini R, De Biase P, Carulli C, et al. The use of an injectable calcium sulphate/calcium phosphate bioceramic in the treatment of osteonecrosis of the femoral head. Int Orthop, 2012, 36(8):1583-1588.
8. Quinlan WR, Brady PG, Regan BF. Fracture of the neck of the femur in childhood. Injury, 1980, 11(3):242-247.
9. 王亦璁. 骨与关节损伤. 4版. 北京:人民卫生出版社, 2007:1153.
10. Kujat R, Suren EG, Rogge D, et al. Femoral neck fractures during the growth period. Treatment principles, results, prognosis. Chirurg, 1984, 55(1):43-48.
11. Hajdu S, Oberleitner G, Schwendenwein E, et al. Fractures of the head and neck of the femur in children:an outcome study. Int Orthop, 2011, 35(6):883-888.
12. Assouline-Dayan Y, Chang C, Greenspan A, et al. Pathogenesis and natural history of osteonecrosis. Semin Arthritis Rheum, 2002, 32(2):94-124.
13. Zhang CQ, Sun Y, Chen SB, et al. Free vascularised fibular graft for post-traumatic osteonecrosis of the femoral head in teenage patients. J Bone Joint Surg (Br), 2011, 93(10):1314-1319.
14. Hughes LO, Beaty JH. Fractures of the head and neck of the femur in children. J Bone Joint Surg (Am), 1994, 76(2):283-292.
15. Abbas AA, Yoon TR, Lee JH, et al. Posttraumatic avascular necrosis of the femoral head in teenagers treated by a modified transtrochanteric rotational osteotomy:a report of three cases. J Orthop Trauma, 2008, 22(1):63-69.
16. Zhao G, Yamamoto T, Ikemura S, et al. Radiological outcome analysis of transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head at a mean follow-up of 12.4 years. J Bone Joint Surg (Br), 2010, 92(6):781-786.
17. Bachiller FG, Caballer AP, Portal LF. Avascular necrosis of the femoral head after femoral neck fracture. Clin Orthop Relat Res, 2002, (399):87-109.
18. Gopinathan NR, Chouhan D, Akkina N, et al. Case report:Bilateral femoral neck fractures in a child and a rare complication of slipped capital epiphysis after internal fixation. Clin Orthop Relat Res, 2012, 470(10):2941-2945.
19. 王本杰, 赵德伟, 郭林, 等. 带血管蒂髂骨瓣移位治疗股骨颈骨折术后股骨头缺血性坏死. 中国修复重建外科杂志, 2011, 25(5):526-529.
20. 朱金强, 沈柏晓, 杨文峰. 带旋髂深血管蒂髂骨及髂骨膜瓣移位治疗中青年股骨颈骨折. 中国修复重建外科杂志, 2009, 23(5):631-632.
21. 梁涛. 带旋髂深血管蒂髂骨骨膜移位修复股骨头缺血性坏死. 中国修复重建外科杂志, 2002, 16(1):73.
22. 官建中, 周建生, 肖玉周, 等. 带血管蒂骨膜瓣移植治疗幼犬股骨头坏死实验研究. 中华显微外科杂志, 2010, 33(3):217-220.
23. Huang GK, Liu ZZ, Shen YL, et al. Microvascular free transfer of iliac bone based on the deep circumflex iliac vessels. J Microsurg, 1980, 2(2):113-120.
24. 黄恭康. 带血管髂骨移植的十年应用经验. 修复重建外科杂志, 1991, 5(2):73-76.
25. Fuchs B, Knothe U, Hertel R, et al. Femoral osteotomy and iliac graft vascularization for femoral head osteonecrosis. Clin Orthop Relat Res, 2003, (412):84-93.
26. 肖玉周, 周建生, 刘振华, 等. 带旋髂深血管骨膜瓣移植治疗儿童股骨头缺血性坏死. 中华显微外科杂志, 2005, 28(1):24-25.

Chinese Journal of Reparative and Reconstructive Surgery

PEDICLED ILIAC PERIOSTEAL FLAP GRAFT FOR AVASCULAR NECROSIS OF FEMORAL HEAD AFTER FEMORAL NECK FRACTURE IN ADOLESCENTS

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