The rendezvous technique for the treatment of ipsilateral femoral neck and shaft fractures: A case series

Conversion hip arthroplasty for failed internal fixation of ipsilateral femoral neck and shaft fractures: a case report

BACKGROUND

Ipsilateral femoral neck and hip fractures are uncommon high energy injuries. In the literature no single method of treatment has emerged as superior to the others. A recent publication has documented the successful application of the rendezvous technique using dual-implants for treating these injuries. However in some cases, this technique may fail and revision surgery is required.

CASE PRESENTATION

A 67-year old man sustained ipsilateral fractures of his femur and femoral neck in a road traffic accident. His injuries were treated by a dual construct consisting of a retrograde femoral nail and dynamic hip screw. Three months after surgery the hip screw cut out of the femoral head necessitating revision to a total hip arthroplasty. Surgery was carried out using a single stage two part procedure on a standard operating table without having to reposition or redrape the patient. There were no postoperative complications and at 1 year from surgery the patient is satisfied with the result and has returned to work.

CONCLUSION

Conversion hip arthroplasty in the presence of dual implants is a technically challenging and unpredictable procedure, with an increased risk of complications. Our surgical approach provides a framework for orthopedic surgeons to safely perform this complex procedure.

Outcomes of Ipsilateral Femoral Neck and Shaft Fractures Treated With Proximal Femoral Nail Antirotation 2

Ipsilateral femoral neck and shaft fractures are relatively rare fractures, which most commonly occur in young adults following high-energy trauma. In most cases of such fractures, neck fracture is undisplaced and often of basicervical type. Many treatment methods have been described, but there is still no generalized consensus on the same. Cephalomedullary nails are one of the preferred modalities of treatment. A cephalomedullary nail-like proximal femoral nail antirotation 2 (PFNA 2) of recent design is being widely used currently. In this study, we present 13 cases of ipsilateral femoral neck and shaft fractures treated with PFNA 2 implants. The advantages of the PFNA 2 system include reduced blood loss, reduced operative time, and fewer fluoroscopy shots. PFNA 2 is a biomechanically better implant than many cephalomedullary implants. It provides satisfactory results in ipsilateral femoral neck and shaft fractures, especially where neck fracture is of a basicervical type. Some aspects have to be taken care of when employing PFNA 2, such as anatomical reduction, and length, angulation, and rotation of both neck and shaft.

Clinicoradiological Outcome of Concomitant Fractures of Proximal Femur and Femoral Shaft Treated With Second-Generation Cephalomedullary Nailing

Background The ideal modality of treatment of concomitant fractures of the hip (intertrochanteric/femoral neck) and the femoral shaft is still evolving. The aim of our retrospective study was to assess the clinicoradiological outcome of such fractures managed by closed second-generation cephalomedullary nailing. Methodology The study was conducted among skeletally mature patients presenting within one week of injury who underwent closed second-generation cephalomedullary nailing (proximal femoral nail). Those presenting beyond one week or those who had pathological fractures, incomplete follow-ups, or other modes of fixation were excluded. Functional results were evaluated according to Friedman and Wyman's clinical assessment system. Time required for fracture healing and the presence of any complications were also noted. Results A total of 10 patients with the ipsilateral hip (five intertrochanteric and five femoral neck) and femoral shaft fractures were included in the study. Associated injuries found included fractures of the ipsilateral tibia/fibula at varying levels in three patients; hand and wrist injuries in two patients; and contralateral femoral shaft fracture, ipsilateral patella, bilateral crush injury of the foot, and head and chest injury with brachial plexus injury in one patient each. Four patients were diagnosed with intra-articular knee injuries (ligamentous and meniscal injuries) postoperatively. At the final follow-up, the functional outcome results were good in four, fair in one, and poor in five patients. All femoral neck fractures united at a mean of 15.2 weeks (range: 12.0-18.0 weeks) and intertrochanteric fractures at a mean of 14.0 weeks (range: 12.0-22.0 weeks). However, there was residual varus malunion in two intertrochanteric fractures. Eight femoral shaft fractures were infra-isthmic; of these, four resulted in nonunion (two of hypertrophic and two of atrophic type) and two were found to be in the delayed union, which eventually united by 24 weeks. Conclusions Second-generation cephalomedullary nail is an acceptable, cost-effective, and minimally invasive alternative for the management of concomitant ipsilateral fractures of the hip and supra-isthmic or isthmic femoral shaft fractures. For infra-isthmic fractures, retrograde femoral nail or distal femoral plate along with a separate implant for addressing the hip fracture (either cannulated cancellous screw or dynamic hip screw, preferably in a rendezvous/overlapping manner) are better options.

Dual-construct fixation is recommended in ipsilateral femoral neck fractures with infra-isthmus shaft fracture: A STROBE compliant study

ABSTRACT

The aim of this study was to evaluate the risk factors related to osteosynthesis failure in patients with concomitant ipsilateral femoral neck and shaft fractures, including old age; smoking habit; comminuted fragments; infra-isthmus fracture; angular malreduction; unsatisfactory reduction (fracture gap >5 mm); and treatment with single construct.Patients over the age of 20 with concomitant ipsilateral femoral neck and shaft fractures diagnosed at a level one medical center between 2003 and 2019 were included. Treatment modalities included single construct with/without an antirotational screw for the neck and dual constructs. Radiographic outcomes were assessed from anteroposterior and lateral hip radiographs at follow-up. Fisher exact test was used to analyze categorical variables. The presence of avascular necrosis of the femoral head, delayed union, atrophic or hypertrophic nonunion of the femoral shaft fracture, and loss of reduction were identified as factors related to treatment failure.A total of 22 patients were included in this study. The average age was 58.5 years, and the majority was male (68.2%). The minimum radiographic follow-up duration was 12 months, and the median follow-up time was 12 (interquartile range 12-24) months.Femoral neck osteosynthesis failed in 3 patients, whereas femoral shaft osteosynthesis failed in 12 patients. Fisher exact test demonstrated the failure of femoral shaft osteosynthesis was significantly more frequent in the single-construct cohort in 16 infra-isthmus femoral fracture cases (P = .034).In ipsilateral femoral neck and infra-isthmus shaft fractures, it is better to treat the neck and shaft fractures with separate implants (dual constructs).In a dual-construct cohort, separate plate fixation of the femoral shaft achieved a better result in terms of bone union than retrograde nailing of the shaft (bone union rate: 4/8 vs 0/2).