Femoral Neck Fracture Non-Union: Treatment with Bone Marrow Concentrate, Demineralized Bone Matrix, and Morselized Allograft and Angular Stable Fixation. Report of 2 Cases.

Introduction: Femoral neck fractures in young adults, particularly Pauwels' 3 fractures with angles exceeding 70°, pose challenges in determining optimal surgical interventions due to limited clinical trial data. Complications such as avascular necrosis, non-union, and shortening hinder the healing process. Existing fixation methods, including multiple cannulated screws and sliding hip screws, have shown non-union rates of nearly 9% in young patients. Bone healing relies on various factors, both patient-independent and patient-dependent, and deficient bone regeneration may necessitate interventions such as cellular supplementation. Case Report: Two cases of Pauwels' 3 fractures in young individuals were treated with a multimodal approach involving mechanical stabilization and biological supplementation. Delayed fracture consolidation and non-union were observed in the initial surgical interventions, leading to the consideration of total hip arthroplasty. However, a second option, involving dynamic hip screw fixation, morselized bone allograft, demineralized bone matrix, and bone marrow concentrate, was chosen based on the patient's age and absence of femoral head necrosis. Both patients successfully achieved bone union and full recovery 6 months postoperatively. Conclusion: The cases underscore the importance of treating femoral neck fractures based on biomechanical principles and highlight the significance of restoring a favorable biological and mechanical environment for fracture healing. A comprehensive approach involving growth factors, bone scaffolds, and mesenchymal stem cells is crucial, along with considerations for the diamond concept, encompassing biomechanics, vascularity, patient factors, and prior bone infection.