Free vascularised fibular grafting has been reportedto be successful for adult patients with osteonecrosis of the femoralhead (ONFH). However, its benefit in teenage patients with post-traumaticONFH has not been determined. We evaluated the effectiveness offree vascularised fibular grafting in the treatment of this conditionin children and adolescents. We retrospectively analysed 28 hipsin 28 patients in whom an osteonecrotic femoral head had been treatedwith free vascularised fibular grafting between 2002 and 2008. Theirmean age was 16.3 years (13 to 19). The stage of the disease attime of surgery, and results of treatment including pre- and post-operativeHarris hip scores, were studied. We defined clinical failure asconversion to total hip replacement. All patients were followedup for a mean of four years (2 to 7). The mean Harris hip scoreimproved from 60.4 (37 to 84) pre-operatively to 94.2 (87 to 100)at final follow-up. At the latest follow-up we found improved orunchanged radiographs in all four initially stage II hips and in23 of 24 stage III or IV hips. Only one hip (stage V) deteriorated.No patient underwent total hip replacement.Free vascularised fibular grafting is indicated for the treatmentof post-traumatic ONFH in teenage patients.
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