Journal of Orthopaedic Reports (Dec 2023)
Meyer's procedure for grade I and II AVN in delayed femoral neck fractures: A retrospective study
Abstract
Background: Femoral neck fractures are challenging injuries that can lead to non-union and avascular necrosis (AVN), particularly in cases of delayed presentation. Muscle pedicle bone grafting has been suggested as a potential approach to supplement blood supply to the fracture site. The objective of this study was to evaluate the efficacy of Meyer's procedure in the treatment of ununited femoral neck fractures with grade I and II AVN, which involves internal fixation and quadratus femoris-based muscle pedicle bone grafting. Methods: Five patients with delayed presentation of femoral neck fractures with grade I and II AVN were included in this retrospective study. The surgical approach for all patients was Meyer's procedure, consisting of open reduction and internal fixation followed by a muscle pedicle graft and cancellous bone graft. Fixation was done with parallel cannulated screws or non-cannulated cancellous screws. In all cases, the quadratus femoris muscle pedicle graft was utilized. The average follow-up duration was three years. Results: All five patients achieved radiological union and reported excellent functional outcomes, including the ability to perform activities such as squatting and sitting cross-legged. According to the Salvatti and Wilson hip rating system, three cases had excellent results, one had good results, and one had fair results. Two cases had coxa vara, and one case had temporary loss of scrotal sensation as complications. Avascular necrosis and transient foot drop were not observed in any cases. Using the modified Harris hip score, all cases achieved good or excellent outcomes, with an average follow-up period of 130 weeks and radiological union occurring at an average of 6.5 months. Conclusion: Meyer's procedure provides stable internal fixation and enhanced blood supply to promote union in ununited femoral neck fractures with grade I and II AVN. This technique can achieve good or excellent functional outcomes and may represent a viable treatment option for patients with these types of fractures. However, further research is needed to confirm these findings and optimize treatment strategies.
