Idiopathic posttraumatic nonunion is a rare condition in children; the treatment of this complication is still controversial in this peculiar population.
Case report
We report a case of a subcapital type II femoral neck fracture, in a 12-year-old boy, which was initially treated by internal fixation and subsequently went on to a nonunion at the femoral neck, in absence of infection or other disease.
1 year after index surgery we performed surgical debridement and refixation with plate and bone allograft, added with autologous bone marrow aspiration concentrate (BMAC) and platelet-rich fibrin (PRF).
After 3 months the nonunion healed and the boy was allowed full weight-bearing.
Conclusions
Combined surgery and adjuvant cell therapy can be considered an option of treatment in nonunion of the femoral neck in the paediatric population.
YeranosianMHorneffJGBaldwinKHosalkarHSFactors affecting the outcome of fractures of the femoral neck in children and adolescents: a systematic review.Bone Joint J201395-B1135–142
2.
ColonnaPCFracture of the neck of the femur in children.Am J Surg1929;6(6):793–797
3.
CanaleSTFractures of the hip in children and adolescents.Orthop Clin North Am1990;21(2):341–352
4.
MorsyHAComplications of fracture of the neck of the femur in children.A long-term follow-up study. Injury2001;32(1):45–51
5.
GranchiDDevescoviVBaglioSRMagnaniMDonzelliOBaldiniNA regenerative approach for bone repair in congenital pseudarthrosis of the tibia associated or not associated with type 1 neurofibromatosis: correlation between laboratory findings and clinical outcome.Cytotherapy2012;14(3):306–314
6.
ZhangBChiuKYWangMHip arthroplasty for failed internal fixation of intertrochanteric fractures.J Arthroplasty2004;19(3):329–333
7.
HammadAAbdel-AalASaidHGBakrHTotal hip arthroplasty following failure of dynamic hip screw fixation of fractures of the proximal femur.Acta Orthop Belg2008;74(6):788–792
8.
PolkowskiGGCallaghanJJMontMAClohisyJCTotal hip arthroplasty in the very young patient.J Am Acad Orthop Surg2012;20(8):487–497
DeakinDEGuyPO'BrienPJBlachutPALefaivreKAManaging failed fixation: valgus osteotomy for femoral neck nonunion.Injury2015;46(3):492–496
11.
LeCroyCMRizzoMGunnesonEEUrbaniakJRFree vascularized fibular bone grafting in the management of femoral neck nonunion in patients younger than fifty years.J Orthop Trauma2002;16(7):464–472
12.
JunXChang-QingZKai-GangZHong-ShuaiLJia-GenSModified free vascularized fibular grafting for the treatment of femoral neck nonunion.J Orthop Trauma2010;24(4):230–235
13.
WangYZhangJWeiWVascularised iliac bone grafting in the treatment of femoral neck nonunion in young adults: a retrospective study.Hip Int2015;25(3):264–269
14.
al-ZahraniSHardingMGKremliMKhanFAIkramATakroniTFree fibular graft still has a place in the treatment of bone defects.Injury1993;24(8):551–554
15.
MishraPKGuptaAGaurSCResults of triple muscle (sartorius, tensor fascia latae and part of gluteus medius) pedicle bone grafting in neglected femoral neck fracture in physiologically active patients.Indian J Orthop2014;48(5):470–475
16.
FlierlMASmithWRMauffreyCet al.Outcomes and complication rates of different bone grafting modalities in long bone fracture nonunions: a retrospective cohort study in 182 patients.J Orthop Surg2013;8(1):33
17.
GiulianiNLisignoliGMagnaniMet al.New insights into osteogenic and chondrogenic differentiation of human bone marrow mesenchymal stem cells and their potential clinical applications for bone regeneration in pediatric orthopaedics.Stem Cells Int2013;2013:312501
18.
NorambuenaGAKhouryMJorgensenCMesenchymal stem cells in osteoarticular pediatric diseases: an update.Pediatr Res2012714 Pt 2452–458
19.
FayazHCGiannoudisPVVrahasMSet al.The role of stem cells in fracture healing and nonunion.Int Orthop2011;35(11):1587–1597
20.
RomagnoliCBrandiMLAdipose mesenchymal stem cells in the field of bone tissue engineering.World J Stem Cells2014;6(2):144–152
