Bone Marrow Injection in Fracture of Femoral Neck

Outcome of Bone Marrow Injection at Fracture Site in Intracapsular Fracture of Femoral Neck Treated by Head Preserving Surgery

Objectives:

• Primary objective :
• To investigate the predisposing factors for femoral neck fractures, including age, sex, and associated comorbidities.
• To investigate the complications associated with intracapsular femoral neck fractures, particularly in young patients.
• To evaluate the effectiveness of autologous bone marrow injection at the femoral neck fracture site and its effect on:
• Achieving complete fracture union.
• Reducing the time required for fracture healing.
• Reducing the incidence of avascular necrosis of the femoral head.
• Secondary objective:

The study addresses the challenge of performing total hip arthroplasty in young patients. Complications following intracapsular femoral neck fractures, particularly avascular necrosis and nonunion, may ultimately necessitate this treatment option. However, total hip arthroplasty is generally less desirable in young patients because of:

• Early prosthetic loosening.
• The potential need for revision arthroplasty later in life due to wear and deterioration of prosthetic components over time.
• Higher complication rates and lower long-term success rates. In this study, we will focus on the use of fully threaded cannulated screws combined with bone marrow injection into the fracture site, and evaluate their effect on the healing and union of intracapsular femoral neck fractures.

Femoral neck fractures are serious injuries associated with a high risk of complications and represent an important challenge in orthopedic practice. Treatment decisions depend on several factors, including the patient's age, physiological status, activity level, associated comorbidities, and fracture displacement. In younger patients and in those with nondisplaced or minimally displaced fractures, internal fixation is generally preferred because preservation of the native femoral head and hip joint is an important treatment goal.

Femoral neck fractures in young patients are usually caused by severe trauma and, although relatively uncommon, are associated with a high incidence of complications. Avascular necrosis (AVN) and late segmental collapse have been reported as major complications following these injuries, with particularly high complication rates described in young patients. Patients with subcapital fractures appear to be more susceptible to these complications. The high risk of AVN is related to the vulnerable blood supply of the femoral head, making preservation of femoral head vascularity a major concern in the treatment of femoral neck fractures.

For younger and active patients with displaced femoral neck fractures, anatomic reduction followed by stable internal fixation is considered essential, while internal fixation is also recommended for ambulatory patients with nondisplaced fractures to prevent secondary displacement. However, despite appropriate internal fixation, complications such as osteonecrosis and nonunion may still occur. The reported rate of osteonecrosis is approximately 10-30%, while nonunion has been reported in 8.9-30% of cases. These complications can lead to prolonged disability and may ultimately require additional surgical treatment.

Autologous bone grafting has traditionally been used to augment bone regeneration in cases of osteonecrosis and nonunion, but its use may be associated with donor-site complications, including pain, bleeding, and infection. Consequently, biological approaches that can enhance fracture healing without the morbidity associated with bone graft harvesting have attracted increasing interest.

Bone marrow(BM) represent a potential alternative biological approach because they contain cell populations with osteogenic and angiogenic potential. Autologous BM transplantation offers several potential advantages, including relatively rapid isolation, avoidance of prolonged cell expansion, preservation of early progenitor characteristics, and the ability to use the cells without a prolonged delay between harvesting and treatment. Previous studies have also suggested beneficial effects of autologous BM in the treatment of femoral head osteonecrosis.

Because prevention of osteonecrosis and nonunion is preferable to treating these complications after they have developed, biological augmentation at the time of fracture fixation may represent a promising strategy. Therefore, combining stable internal fixation with an autologous biological treatment may provide a potential approach to improving fracture healing and reducing the risk of complications in patients with femoral neck fractures.

Inclusion Criteria:

• Age between 18 and 55 years.
• Intracapsular femoral neck fracture classified as Garden type III or IV.
• The time elapsed since the fracture occurred must not exceed 24 hours

Exclusion Criteria:

• Age under 18 years or over 55 years.
• Open femoral neck fracture.
• Neglected femoral neck fractures or fractures that occurred more than 24 hours prior to presentation.
• Polytrauma patients who are in shock or admitted to the intensive care unit (ICU).