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Abstract Objective To explore the early and medium-term effect of sartorius musculoskeletal flap transfer for treating old femoral neck fracture among young adults.Methods 11 cases (7 males and 4 females) with old femoral neck fracture were admitted to our department from July 2009 to July 2016，with a mean age of 32.8 years old (18～46 years old) and a mean time of injury of 10.3 weeks(8～18 weeks).Injury causes included traffic accident (9 cases) and high falling accident (2 cases).Garden classification was as follows：I (0 case)，Ⅱ(1 case)，Ⅲ(1 case) and Ⅳ(3 cases).All patients underwent open reduction and internal fixation with 3 hollow lag screws through Smith-Petersen approach.A bone groove of 4.0 cm ×1.5 cm×1.0 cm was made with the anterior facture line of femoral neck as the center，then a sartorius muscle iliac flap was transplanted into the groove and fixed with full thread absorbable screws.Anteroposterior and lateral X-ray films of the hip joint were observed to evaluate facture healing and Harris hip score within 3 days，1 month，3 months，6 months，12 months and 24 months after operation，respectively.Results Among the 11 patients，1 patient died in an accident and lost to follow up，while 10 patients were followed up completely，with an average follow-up period of 38.3 months (13～83 months).Femoral neck fracture was healed in these 10 patients，with a mean healing time of 11.2 months (9～15 months).Lateral-superior femoral head collapse was found in 1 patient at 12 month follow-up，with no joint space narrowing.However，due to obvious hip joint pain，the patient underwent total hip replacement.The average Harris scores of the affected hip joint three days，1 month，3 months，6 months，12 months and 24 months after operation were 73.4，76.1，75.3，86.6，89.6 and 90.7，respectively.Conclusion Sartorius muscle blood supply appears to be segmental and vessels can be reserved.It is possible to perform sartorius musculoskeletal flap transfer in order to improve the blood supply of the fracture end and promote the healing of old femoral neck fracture among young adults.
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