Dual-Bone Grafting Technique of Neck Reconstruction in Non-union Neck Femur Fracture With Avascular Necrosis of the Femur Head.

A 36-year-old male farmer with known sickle cell disease presented four months after a road traffic accident with right hip pain and difficulty walking. He had initially received conservative treatment with traction but discontinued it due to financial constraints. Clinical examination revealed signs of hip instability, a 3 cm true limb shortening, and a Harris Hip Score of 38. Imaging showed a Sandhu Stage 3 non-union of the femoral neck with >50% neck resorption and Ficat-Arlet Grade 2a avascular necrosis (AVN). Given the relatively favorable prognostic indicators, including a Kerboul angle of 100°, the patient opted for a joint-preserving procedure to retain his ability to squat and perform manual labor. The patient underwent osteosynthesis through a modified Heuter approach. A 3 cm tricortical iliac crest graft was used to bridge the fracture gap and restore neck length, supported by a fully threaded cannulated cancellous (CC) screw. A 7 cm non-vascularized fibular strut graft was introduced across the fracture and further stabilized using a Pauwels screw and an additional CC screw. Postoperatively, he was mobilized non-weight-bearing for six weeks, followed by gradual weight-bearing. Radiographs at six months showed union, and at three years, the patient had minimal shortening, no pain, resumed full activities, and achieved a Harris Hip Score of 85.