Recent Concept for Management of Femoral Neck Fracture Non-Union in Young Adults

Fractures of the neck of femur in young adults tend, unlike their counterparts in older people, to be a relatively higherenergy injury and require timely and meticulous diagnosis and management [1-4]. Anatomical reduction and stable internal fixation are essentials for achieving the goals of treatment in this young population allowing preservation of the femoral head while minimizing rates of non-union and osteonecrosis [1]. A delayed presentation of fracture of the femoral neck is one where there is a delay of 48 hours to 20 days between injury and diagnosis, whereas in a neglected fracture, this delay is in excess of 21 days [3]. While all femoral neck fractures are life-changing injuries, the neglected fracture in a young adult below the age of 60 years is one of the most challenging to treat and arguably has the most at stake [2]. The main complications of such injuries are a vascular necrosis (AVN) of the femoral head and non-union of the fracture with reported average incidences of 15% for AVN and 12% for non-union [2,3]. There are no clear guidelines for management of these fractures, although multiple methods have been used with varying success. In these individuals extreme force is required to produce fracture which explains the increased incidence of AVN & nonunion. In underdeveloped countries because of poverty, ignorance & lack of facilities these delayed presentation or nonunion is common [1-5]. The purpose of the current study is to assess treatment outcomes in adults with neglected femoral neck fractures, and propose a treatment protocol based on bone quality.