TREATMENT OF THE NECROTIC HEAD OF THE FEMUR IN ADULTS

¹ Department of Surgery, The University of Chicago

Two cases of necrosis of the head of the femur, one associated with an ununited fracture of the neck and the other with an ununited fracture at the junction of the head and neck, which developed after healing of a primary fracture located distally in the neck, were treated by drilling two holes across the neck and upper portion of the head and the insertion of a rectangular tibial bone graft into each hole. The fractures united promptly and the upper portion of the head was rapidly invaded and replaced by new bone, thereby avoiding collapse of the head from weight-bearing. In one patient, function was restored practically to normal and there was little roentgenographic evidence of degenerative arthritis, seven and one-half years after operation. An equally promising result was present in the other patient at the end of twelve and one-half months.

In a third case of ununited fracture with death of the head of two years' duration, the lower bone graft was inserted across the fracture line deep into the head, while the upper graft was inserted only to the margin of the upper portion of the head. Bony union occurred promptly; but, beginning sixteen months after operation, the upper portion of the head, which had not been drilled and supported by a graft, underwent collapse and absorption, and a poor functional result was obtained.

The cases present evidence that drilling and bone-pegging of the upper portion of the necrotic head of the femur which has undergone little or no collapse may increase the rate of transformation of the structure into living bone, shorten the non-weight-bearing period, and decrease the incidence of collapse, deformity, degenerative arthritis, and poor functional results.

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