Ununited femoral neck fractures by open reduction and vascularized iliac bone graft

Neglected femoral neck fractures are frequently complicated with nonunion and avascular necrosis of the femoral head. The treatment is especially difficult in young adults because arthroplasty is not indicated. Five cases of neglected femoral neck fractures in young patients were treated by open reduction and internal fixation with pins. The defect of the femoral neck was filled with a block of vascularized iliac bone graft. After at least two years, the fractures were healed without avascular necrosis of the femoral head. The leg-length discrepancy was corrected in all but one case. The pedicled iliac graft provided a viable bone graft, which maintained the viability of the head and hastened fracture healing.