Functional Outcome of Quadratus Femoris Muscle Pedicle Bone Graft with Internal Fixation in Neglected Fracture Neck of Femur

Abstract

Aim: To evaluate the functional and radiological outcomes of quadratus femoris muscle pedicle bone grafting with internal fixation
in patients with neglected fracture neck of femur.
Materials and Methods: A retrospective observational study was conducted in the Department of Orthopaedics, Darbhanga Medical
College and Hospital, Laheriasarai, Darbhanga, Bihar, India, over a period of two years. Fourteen patients diagnosed with neglected
fracture neck of femur who underwent quadratus femoris muscle pedicle bone grafting with internal fixation were included. Demographic
characteristics, fracture pattern, duration between injury and surgery, operative details, radiological union, complications, and functional
outcomes assessed using the Harris Hip Score (HHS) were retrieved from hospital records. Descriptive statistics were used to summarize
the data. Fisher’s exact test and Mann–Whitney U test were applied where appropriate, with statistical significance set at p < 0.05.
Results: The mean age of the patients was 37.9 ± 10.8 years, with males comprising 64.3% of the study population. The average
interval between injury and surgery was 9.1 ± 3.8 weeks, and the mean follow-up duration was 16.8 ± 5.4 months. Radiological union
was achieved in 12 (85.7%) patients, with a mean union time of 5.8 ± 1.2 months. The mean Harris Hip Score at final follow-up was
85.1 ± 11.3. Excellent and good functional outcomes were observed in 64.3% of patients. One patient (7.1%) developed avascular
necrosis, two (14.3%) had non-union, and one (7.1%) experienced superficial wound infection. Earlier surgical intervention was
associated with better functional outcomes (p = 0.03).
Conclusion: Quadratus femoris muscle pedicle bone grafting with internal fixation demonstrated satisfactory radiological union and
favorable functional outcomes while maintaining a relatively low complication rate in patients with neglected fracture neck of femur.
This technique appears to be an effective femoral head-preserving procedure for carefully selected young and active patients. Larger
prospective studies with longer follow-up are required to confirm these findings.
Background: Neglected fracture neck of femur remains a challenging orthopedic condition, particularly in young and active individuals,
because of the high risks of non-union and avascular necrosis (AVN). Quadratus femoris muscle pedicle bone grafting combined with
internal fixation has been proposed as a biological augmentation technique to improve fracture healing by enhancing vascularity and
providing mechanical stability.