Management of Neglected Fracture Neck of Femur by Internal Fixation and Tensor Fascia Lata Muscle Pedicle Grafting: A Prospective Study

<p><strong>Background:</strong> Fractures of the neck of the femur have always presented great challenges to Orthopaedic Surgeons and remain in many ways today the unsolved fracture as far as treatment and results are concerned.</p> <p><strong>Methods:</strong> Early anatomical reduction, compression of the fracture, and rigid internal fixation are used to promote union, but the surgeon probably has less control over osteonecrosis as the blood supply to the femoral head after femoral neck fracture is quite precarious. Many different devices have been devised for internal fixation of femoral neck fractures, but currently two are commonly used. They are multiple cannulated screws and Dynamic Hip Screw with an additional anti-rotation screw. We studied 14 cases of 1 month-to-one year old fracture neck of femur. All of them had viable head of femur. There was varying degree of resorption of neck of femur, One patient had pathological fracture neck of femur but head of femur was viable. 12 cases were treated with closed reduction, internal fixation with cannulated cancellous screws, augmented with Tensor fascia lata (TFL) muscle pedicle graft to the neck of femur .2 cases were treated with closed reduction, internal fixation with Dynamic hip screw, augmented with TFLMuscle pedicle graft to the neck of femur .</p> <p><strong>Results: </strong>12 cases showed union of fracture, 2 cases were lost in follow up, all 12 patients were able to return to routine daily activities, and one case had avascular necrosis (AVN) with poor function of hip.</p> <p><strong>Conclusion: </strong>Fracture neck of femur new or old when treated with stable reduction, alignment as per Garden's index, rigid internal fixation with augmentation by Tensor fascia muscle pedicle grafting for re-establishment of vascularity to head of the femur resulted in 100 % union.</p>