Early effectiveness of surgical hip dislocation combined with autologous iliac crest bone grafting in treatment of femoral neck fracture nonunion in adolescents_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Jun ¹ , JIN Liang ² , BAO Tao ³ , HUANG Haifeng ⁴ , SUN Li ⁴ ,  YANG Xianteng ⁴

1. Department of Orthopedics and Traumatology, the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang Guizhou, 550025, P. R. China;
2. Department of Orthopedics, Qingzhen Hospital of Traditional Chinese Medicine, Qingzhen Guizhou, 551400, P. R. China;
3. The First Clinical Institute, Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China;
4. Department of Orthopedics, Guizhou Provincial People’s Hospital, Guiyang Guizhou, 550002, P. R. China;

Corresponding?author：

YANG Xianteng, Email: yangxian.teng@163.com

Keywords：

Femoral neck fracture nonunion; surgical hip dislocation; autogenous iliac bone grafting; adolescents; hip preserving

DOI：

10.7507/1002-1892.202511074

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Objective To investigate the early effectiveness of surgical hip dislocation (SHD) combined with autologous iliac crest bone grafting in the treatment of femoral neck fracture nonunion in adolescents. Methods Between December 2020 and August 2024, 21 adolescent patients with femoral neck fracture nonunion were treated with SHD combined with autogenous iliac bone grafting. There were 16 males and 5 females, aged 15-25 years (mean, 19.1 years). According to the Pauwels classification, there were 8 cases of type Ⅱ fractures and 13 cases of type Ⅲ fractures. After the initial fracture, 18 patients had undergone reduction and internal fixation, while 3 had received conservative treatment. The interval from fracture to the operation was (12.0±9.3) months. Preoperatively, the Harris score was 52.0±4.2, the International Hip Outcome Tool-12 (iHOT-12) score was 45.6±3.2, and the visual analogue scale (VAS) score for pain was 5.1±0.8. Postoperative imaging was reviewed to assess femoral neck fracture healing and whether secondary collapse of the femoral head occurred. The Harris score, iHOT-12 score, VAS score, and complications were evaluated. Results All patients were followed up 12-55 months (mean, 27.7 months). During follow-up, no avascular necrosis of the femoral head, heterotopic ossification, infection, or other complications occurred. At last follow-up, the Harris score, iHOT-12 score, and VAS score were 88.1±4.4, 74.7±5.6, and 1.2±0.6, respectively, all of which significantly improved when compared with preoperative values (P<0.05). In all 21 cases, callus formation was observed at the fracture ends of the femoral neck, with good autogenous bone support and new bone formation in the femoral head and neck, and no collapse of the femoral head was observed. Internal fixator was removed in 5 patients at (25.8±7.1) months postoperatively. Conclusion SHD combined with autologous iliac crest bone grafting has a good early effectiveness in the treatment of femoral neck fracture nonunion in adolescents. The technique not only protects the blood supply of the femoral head, but also fully exposes the structure of the femoral neck fracture, allowing for sufficient freshness, bone grafting, and fixation treatment of the fracture end, thereby achieving good bone healing.

Citation： ZHANG Jun, JIN Liang, BAO Tao, HUANG Haifeng, SUN Li, YANG Xianteng. Early effectiveness of surgical hip dislocation combined with autologous iliac crest bone grafting in treatment of femoral neck fracture nonunion in adolescents. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(6): 912-917. doi: 10.7507/1002-1892.202511074 Copy

1.	Rajfer RA, Carlson BA, Johnson JP. High-energy femoral neck fractures in young patients. J Am Acad Orthop Surg, 2024, 32(7): e302-e312.
2.	Feng S, Yu HH, Wang L, et al. Incidence and risk factors for fixation failure of femoral neck fractures in adults: a single-center multifactorial analysis. Langenbecks Arch Surg, 2026, 411(1): 102. doi: 10.1007/s00423-026-03997-5.
3.	Goh EL, Png ME, Metcalfe D, et al. The impact of complications on quality of life and mortality after hip fracture. Bone Joint J, 2025, 107-B(10): 1118-1124.
4.	Zong X, Xu K, Yu X, et al. Femoral neck system versus total hip arthroplasty in the treatment of Pauwels type Ⅲ unstable femoral neck fractures in patients aged 60-70 years: a comparative analysis of clinical efficacy and hip function. Orthop Surg, 2026, 18(3): 402-411.
5.	姜達君, 賈偉濤, 張長青. 青壯年股骨頸骨折復位技巧和內固定選擇. 中華創傷骨科雜志, 2018, 20(7): 588-593.
6.	Dagneaux L, Abdel MP, Sierra RJ, et al. Total hip arthroplasty in patients with angular proximal femoral deformities. Bone Joint J, 2025, 107-B(6 Supple B): 101-108.
7.	Zhang C, Zeng B, Xu Z, et al. Treatment of femoral head necrosis with free vascularized fibula grafting: a preliminary report. Microsurgery, 2005, 25(4): 305-309.
8.	Lin S, Zhang CQ, Jin DX. Combination of modified free vascularized fibular grafting and reverse Less Invasive Stabilization System (LISS) for the management of femoral neck nonunion in patients thirty years of age or younger. Injury, 2015, 46(8): 1551-1556.
9.	Richard MJ, DiPrinzio EV, Lorenzana D. Outcomes of free vascularized fibular graft for post-traumatic osteonecrosis of the femoral head. Injury, 2021, 52(12): 3653-3659.
10.	Wu Y, Song M, Peng G, et al. Muscle pedicle bone flap transplantation for treating femoral neck fracture in adults: a systematic review. J Orthop Surg Res, 2021, 16(1): 304. doi: 10.1186/s13018-021-02448-9.
11.	Janik S, Hirtler L, Traxler H, et al. The vascularized fascia lata free flap: an anatomical study and clinical considerations. Eur Arch Otorhinolaryngol, 2020, 277(6): 1733-1739.
12.	Ganz R, Gill TJ, Gautier E, et al. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg (Br), 2001, 83(8): 1119-1124.
13.	Wittauer M, Burch MA, Vandendriessche T. Definition of long-bone nonunion: A scoping review of prospective clinical trials to evaluate current practice. Injury, 2021, 52(11): 3200-3205.
14.	孫偉, 高福強, 李子榮. 股骨頭壞死臨床診療技術專家共識(2022年). 中國修復重建外科雜志, 2022, 36(11): 1319-1326.
15.	Meermans G, Konan S, Das R, et al. The direct anterior approach in total hip arthroplasty: a systematic review of the literature. Bone Joint, 2017, 99-B(6): 732-740.
16.	Patterson JT, Ishii K, Morshed S. Smith-Petersen versus Watson-Jones approach does not affect quality of open reduction of femoral neck fracture. Orthop Trauma, 2021, 35(10): 517-522.
17.	Takemoto N, Nakamura T, Yamamoto D. Clinical outcomes of total hip arthroplasty with the anterolateral modified Watson-Jones approach for displaced femoral neck fractures. Geriatr Orthop Surg Rehabil, 2022, 13: 21514593221134800. doi: 10.1177/21514593221134800.
18.	殷勇, 楊靜, 謝成, 等. 不同手術入路行全髖關節置換術對髖臼假體位置及術后早期髖關節功能影響的臨床研究. 創傷外科雜志, 2019, 21(5): 362-366.
19.	Claassen H, Schmitt O, Schulze M, et al. Deep femoral artery: A new point of view based on cadaveric study. Ann Anat, 2021, 237: 151730. doi: 10.1016/j.aanat.2021.151730.
20.	秦宇星, 任前貴, 李子龍, 等. 骨微血管內皮細胞在股骨頭壞死中的作用機制及前景. 中國組織工程研究, 2023, 27(6): 955-961.
21.	李振偉, 黃德剛. 外科脫位技術在髖關節相關疾病中的應用進展. 中國矯形外科雜志, 2018, 26(11): 1022-1025.
22.	Abdelnasser MK, Refai O, Farouk O. Surgical hip dislocation in fixation of acetabular fractures: Extended indications and outcome. Injury, 2022, 53(2): 539-545.
23.	Chen W, Li J, Guo W, et al. Outcomes of surgical hip dislocation combined with bone graft for adolescents and younger adults with osteonecrosis of the femoral head: a case series and literature review. BMC Musculoskelet Disord, 2022, 23(1): 499. doi: 10.1186/s12891-022-05456-w.
24.	Jiang D, Cao J, Zhao J, et al. Clinical outcomes of femoral neck fractures in nongeriatric patients: a comparative analysis of parallel screws, alpha fixation and femoral neck system. Int Orthop, 2025, 49(12): 2829-2836.
25.	Hosny H, Mousa S, Salama W. Management of femoral head fracture by Ganz surgical dislocation of the hip. Orthop Traumatol, 2022, 23(1): 334-342.
26.	楊先騰, 張洪, 羅殿中, 等. 股骨頭縮小成形術治療大頭髖或扁平髖畸形的早期療效. 中華骨科雜志, 2017, 37(15): 942-951.
27.	Khalifa AA, Refai O, Farouk O, et al. Management of femoral head fractures through surgical hip dislocation (SHD): a demanding but safe technique. Arch Orthop Trauma Surg, 2021, 141(10): 1701-1710.

1. Rajfer RA, Carlson BA, Johnson JP. High-energy femoral neck fractures in young patients. J Am Acad Orthop Surg, 2024, 32(7): e302-e312.
2. Feng S, Yu HH, Wang L, et al. Incidence and risk factors for fixation failure of femoral neck fractures in adults: a single-center multifactorial analysis. Langenbecks Arch Surg, 2026, 411(1): 102. doi: 10.1007/s00423-026-03997-5.
3. Goh EL, Png ME, Metcalfe D, et al. The impact of complications on quality of life and mortality after hip fracture. Bone Joint J, 2025, 107-B(10): 1118-1124.
4. Zong X, Xu K, Yu X, et al. Femoral neck system versus total hip arthroplasty in the treatment of Pauwels type Ⅲ unstable femoral neck fractures in patients aged 60-70 years: a comparative analysis of clinical efficacy and hip function. Orthop Surg, 2026, 18(3): 402-411.
5. 姜達君, 賈偉濤, 張長青. 青壯年股骨頸骨折復位技巧和內固定選擇. 中華創傷骨科雜志, 2018, 20(7): 588-593.
6. Dagneaux L, Abdel MP, Sierra RJ, et al. Total hip arthroplasty in patients with angular proximal femoral deformities. Bone Joint J, 2025, 107-B(6 Supple B): 101-108.
7. Zhang C, Zeng B, Xu Z, et al. Treatment of femoral head necrosis with free vascularized fibula grafting: a preliminary report. Microsurgery, 2005, 25(4): 305-309.
8. Lin S, Zhang CQ, Jin DX. Combination of modified free vascularized fibular grafting and reverse Less Invasive Stabilization System (LISS) for the management of femoral neck nonunion in patients thirty years of age or younger. Injury, 2015, 46(8): 1551-1556.
9. Richard MJ, DiPrinzio EV, Lorenzana D. Outcomes of free vascularized fibular graft for post-traumatic osteonecrosis of the femoral head. Injury, 2021, 52(12): 3653-3659.
10. Wu Y, Song M, Peng G, et al. Muscle pedicle bone flap transplantation for treating femoral neck fracture in adults: a systematic review. J Orthop Surg Res, 2021, 16(1): 304. doi: 10.1186/s13018-021-02448-9.
11. Janik S, Hirtler L, Traxler H, et al. The vascularized fascia lata free flap: an anatomical study and clinical considerations. Eur Arch Otorhinolaryngol, 2020, 277(6): 1733-1739.
12. Ganz R, Gill TJ, Gautier E, et al. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg (Br), 2001, 83(8): 1119-1124.
13. Wittauer M, Burch MA, Vandendriessche T. Definition of long-bone nonunion: A scoping review of prospective clinical trials to evaluate current practice. Injury, 2021, 52(11): 3200-3205.
14. 孫偉, 高福強, 李子榮. 股骨頭壞死臨床診療技術專家共識(2022年). 中國修復重建外科雜志, 2022, 36(11): 1319-1326.
15. Meermans G, Konan S, Das R, et al. The direct anterior approach in total hip arthroplasty: a systematic review of the literature. Bone Joint, 2017, 99-B(6): 732-740.
16. Patterson JT, Ishii K, Morshed S. Smith-Petersen versus Watson-Jones approach does not affect quality of open reduction of femoral neck fracture. Orthop Trauma, 2021, 35(10): 517-522.
17. Takemoto N, Nakamura T, Yamamoto D. Clinical outcomes of total hip arthroplasty with the anterolateral modified Watson-Jones approach for displaced femoral neck fractures. Geriatr Orthop Surg Rehabil, 2022, 13: 21514593221134800. doi: 10.1177/21514593221134800.
18. 殷勇, 楊靜, 謝成, 等. 不同手術入路行全髖關節置換術對髖臼假體位置及術后早期髖關節功能影響的臨床研究. 創傷外科雜志, 2019, 21(5): 362-366.
19. Claassen H, Schmitt O, Schulze M, et al. Deep femoral artery: A new point of view based on cadaveric study. Ann Anat, 2021, 237: 151730. doi: 10.1016/j.aanat.2021.151730.
20. 秦宇星, 任前貴, 李子龍, 等. 骨微血管內皮細胞在股骨頭壞死中的作用機制及前景. 中國組織工程研究, 2023, 27(6): 955-961.
21. 李振偉, 黃德剛. 外科脫位技術在髖關節相關疾病中的應用進展. 中國矯形外科雜志, 2018, 26(11): 1022-1025.
22. Abdelnasser MK, Refai O, Farouk O. Surgical hip dislocation in fixation of acetabular fractures: Extended indications and outcome. Injury, 2022, 53(2): 539-545.
23. Chen W, Li J, Guo W, et al. Outcomes of surgical hip dislocation combined with bone graft for adolescents and younger adults with osteonecrosis of the femoral head: a case series and literature review. BMC Musculoskelet Disord, 2022, 23(1): 499. doi: 10.1186/s12891-022-05456-w.
24. Jiang D, Cao J, Zhao J, et al. Clinical outcomes of femoral neck fractures in nongeriatric patients: a comparative analysis of parallel screws, alpha fixation and femoral neck system. Int Orthop, 2025, 49(12): 2829-2836.
25. Hosny H, Mousa S, Salama W. Management of femoral head fracture by Ganz surgical dislocation of the hip. Orthop Traumatol, 2022, 23(1): 334-342.
26. 楊先騰, 張洪, 羅殿中, 等. 股骨頭縮小成形術治療大頭髖或扁平髖畸形的早期療效. 中華骨科雜志, 2017, 37(15): 942-951.
27. Khalifa AA, Refai O, Farouk O, et al. Management of femoral head fractures through surgical hip dislocation (SHD): a demanding but safe technique. Arch Orthop Trauma Surg, 2021, 141(10): 1701-1710.

Chinese Journal of Reparative and Reconstructive Surgery

Early effectiveness of surgical hip dislocation combined with autologous iliac crest bone grafting in treatment of femoral neck fracture nonunion in adolescents

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