the femoral head often leads to healing complications , while the more predictable prosthetic replacements are associated with poorer function and significant complications . the treatment of these fractures depends on the age of the patient , fracture displacement , bone quality , timing of surgery and activity level of the patient . displaced fractures in healthy , active patients are best treated by reduction and internal fixation . there are however , complications unique to femoral neck fractures which are almost impossible to predict . non - union and avascular necrosis non - union usually can definitely diagnosed within a year of fracture fixation with the same being achieved within 3  months at times . after non - union has been established , intervention is inevitable . the decision to proceed in the management of failed fixation is based on the careful consideration of various factors . in young patients revision internal fixation with cancellous or muscle pedicle bone grafting ( vascularised bone graft ) or an osteotomy results in useful outcome . we report a case of non - union of the fracture of the neck of the femur , who refused additional procedures after his non - union had been established . the study conforms to the declaration of helsinki and was approved by the institutional ethical board . a 38-year old male businessman reported to the out door department of our hospital with a history of a fall from height . clinical and radiological examination revealed a displaced fracture of the neck of the femur which was graded as garden type 4 ( fig . the patient was operated within 24  h. intraoperatively the garden alignment index was used as a yardstick of acceptable reduction . the fracture was fixed with 3 ao 6.5  mm cannulated screws in an inverted triangle . onward the patient complained of persistent but mild groin pain on ambulation which was assisted . the patients conservative line was continued till 1  year when his symptoms continued and radiologically there was no progress . at this point twenty - six  months into the post operative followup the patients pain subsided and radiographs started showing signs of union . a radiograph taken 32  months after the fixation showed full union . non - union after femoral neck fracture can be defined as a lack of radiographic evidence of union 6  months after the fracture . delayed or non - union often manifests as continued pain with weight bearing beyond 3  months post fixation . incidence of non - union of femoral neck fractures has been reported to be between 2 and 22% and generally becomes apparent within 1  year [ 69 ] . 3radiograph at 32  months depicting union garden 4 type fracture of the neck of the femur showing persistent non - union at 2  years radiograph at 32  months depicting union anatomical reduction and rigid internal fixation are the two important surgeon controlled factors that may contribute to outcome . the preferred treatment for symptomatic non - unions in the elderly is prosthetic replacement . in the young active patients , if failure is due to technical errors , revision open reduction and internal fixation may be adequate . our case demonstrates that as long as the implant is holding and the patient is regularly followed up good results might be expected in cases as far as 32  months into the post fixation period .
fracture of the femoral neck continues to be a vexing clinical and therapeutic challenge for the orthopedic surgeon . 
 the fracture has a propensity for non - union and avascular necrosis . 
 it is a challenge for the orthopedic surgeon to decide when to intervene in a case with non - union where the implant continues to be in place . 
 we present a case with persistent clinical and radiological non - union signs where the fracture eventually united after 32  months . 
 the case bolsters the view that a continued conservative regime might entail good results in such situations .