Alternatives in the treatment of ipsilateral fractures of the hip and femur

Treatment of ipsilateral femoral neck and shaft fractures

OBJECTIVE

To investigate the clinical characteristics, treatment options and causes of misdiagnosis of ipsilateral femoral neck and shaft fractures.

METHODS

Among 20 patients with ipsilateral femoral neck and shaft fractures, 19 were treated operatively and 1 was treated conservatively. Sixteen cases of femoral shaft fractures were treated by open reduction and internal fixation with compressive plate, and 2 cases were treated with interlocking intramedullary nailing. Eighteen femoral neck fractures were treated with cannulated screws. Another patient was treated with proximal femoral nail to fix both the neck and shaft. Delayed diagnosis for femoral neck fractures occurred in 2 cases preoperatively.

RESULTS

A total of 19 patients were followed up. The follow up period ranged from 5 to 48 months with an average of 15 months. All the fractures were healed.

CONCLUSION

For case of femoral shaft fracture caused by high energy injury, an AP pelvic film should be routinely taken. Once the femoral neck fracture is recognized, operative reduction and fixation should be performed in time. Femoral neck and shaft fractures should be fixed separately.

Concurrent ipsilateral fractures of the hip and femoral shaft: a meta-analysis of 659 cases

659 cases of concurrent, ipsilateral fractures in the hip and femoral shaft reported in 59 studies were analyzed. The causes were a road traffic accident in 78% and other types of high-energy traumas in 13% of the patients. This injury combination was rare in children. The median age was 34 years. 78% of the patients were men. One-third had multiple injuries, one-half had injuries of the ipsilateral knee and one-half had other lower limb injuries. The femoral neck fractures were most often basilar and the reported rate of avascular necrosis was 3%. The trochanteric fractures were intertrochanteric transverse, and seldom comminuted. The important factors in reducing morbidity were an early diagnosis of all injuries and efficient treatment of the shaft fractures. Locked intramedullary nails yielded results which were superior to combinations of plates or unlocked nails and separate hip screws. Reconstruction nails (cephalomedullary nails) gave results equal to those of customary locked nails and separate hip screws. The rate of healing of the hip fracture was over 99%, the treatment of the shaft fracture being of main importance for the outcome.

Ipsilateral femoral neck and shaft fractures. Retrospective study of 33 cases

Forty-two consecutive adult patients with a concomitant ipsilateral femoral neck and shaft fracture were treated. The neck fracture was initially missed in 7 patients. Surgery was delayed for a median of 7 days because of the patients' poor general conditions. Thirty-three patients were followed up for 2 (1-6) years. All 33 necks healed, with a union period of 3.3 +/- 1.7 months; and 28 shafts healed after 7.9 +/- 1.8 months. Thus, the femoral shaft determined the total union rate and union period. All the complications, (eight out of 33) occurred in the open procedure group. Our series reveals that ipsilateral femoral neck and shaft fractures have a relatively satisfactory outcome. Closed Küntscher's nailing or interlocking nailing with supplementary Knowles' pinning is the preferable technique.