A Retrospective Review of High-Energy Femoral Neck-Shaft Fractures

Abstract

This study found a similar rate of neck-shaft combinations (3.2%), a higher rate of open fractures, and increased incidence of associated injuries compared with the literature. Most importantly, our data indicate that even with a negative preoperative computed tomography scan, a femoral neck fracture can be present. A trend also indicated more missed femoral neck fractures with retrograde nailing, which may be attributed to less fluoroscopic imaging of the hip with this technique. Patients with femoral shaft fractures should have good quality radiographs after femoral nailing to minimize the risk of missed femoral neck fractures.

Ipsilateral Proximal Femur and Shaft Fractures Treated With Hip Screws and a Reamed Retrograde Intramedullary Nail

“…A recent meta-analysis showed strong evidence suggesting that reamed IM nails had a higher union rate than unreamed IM nails, again confirmed by our recent investigation [5]. Most recently, a multicenter retrospective review of 76 high-energy ipsilateral femoral neck and shaft fractures treated by a variety of surgeons with fixation determined by surgeon discretion found complications in patients treated with proximal cannulated screws and a retrograde IM nail [7]. In the group where the femoral neck fracture was identified early, 33 were treated with cannulated screws and 16 with a sliding hip screw with a secondary retrograde IM nail.…”

Is Reconstruction Nailing of All Femoral Shaft Fractures Cost Effective? A Decision Analysis

“…This value is greater than the reported mean in the literature, 5%, but within the reported range. 1,2,5,8,13,14,19 Our analysis also demonstrated that the rate of missed femoral neck fractures must be .38% for the routine use of reconstruction nailing in femur fractures to be cost effective. The reported rates of missed femoral neck fractures are from 19% to 55%, and some recent literature has shown that experienced trauma surgeons still miss 22% of these fractures.…”

“…The reported rates of missed femoral neck fractures are from 19% to 55%, and some recent literature has shown that experienced trauma surgeons still miss 22% of these fractures. 8 If the incremental costs of reconstruction nailing are ,$360 then the missed femoral neck fracture must be .22% for reconstruction nailing to be the preferred strategy (Fig. 5).…”

“…6,8,12,13,32 Like standard proximal locking screws, reconstruction locking screws are inserted using a radiolucent guide attached to the proximal nail; therefore, the technical difficulty of the nailing is not dramatically different. Currently, several, but not all, newer femoral nails are designed for reconstruction nailing using both trochanteric and piriformis starting points.…”

“…[1][2][3][4][5][6]9,13,14,[18][19][20][21] The rates of ipsilateral neck and shaft fractures and of missed femoral neck fractures and the probabilities of complications of missed and treated femoral neck fractures were obtained from the literature and were averaged using a weighted average. 3,4,8 The rates of avascular necrosis and nonunion were combined as complications, and this weighted average was used as the base rate in the model. The authors estimated the probability of complications of empiric intervention using a reconstruction nail from a recent study of this technique for all femoral shaft fractures without clear radiographic evidence of an ipsilateral neck fracture and from the literature regarding femoral head penetration by implants in the treatment of subtrochanteric femur fractures.…”