Although the bone graft is always mentioned in any discussion concerning the treatment of ununited fractures of the neck of the femur, it has been used for only a small percentage of patients afflicted with such fractures. At the Mayo Clinic only 1 in 10 of the patients who came with ununited fractures of the neck of the femur were subjected to a bone grafting procedure. The chief reason for the infrequent use of this type of operation is that most patients with ununited fracture of the neck of the femur are seen by the surgeon when the femoral neck is practically absorbed. Local conditions at the site of fracture being thus unfavorable and the open operation (intra-articular osteosynthesis) being too extensive and complicated to be employed indiscriminately for elderly patients, the use of the bone graft has been limited to a smaller group of younger, more robust patients.
HENDERSON MS. EXTRA-ARTICULAR OSTEOSYNTHESISFOR NONUNION OF FRACTURE OF THE NECK OF THE FEMUR. Arch Surg. 1941;42(3):557-565. doi:10.1001/archsurg.1941.01210090106009