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.