Double fractures of the femur: a review of 16 patients

Abstract

Background Double ipsilateral femoral fractures account for 1-9% of femoral fractures. There is no clear advantage between single or double implant osteosynthesis. We present a series of patients with double ipsilateral femoral fractures, to address the challenges in treatment, namely the implants for osteosynthesis and complications of treatment. Materials and methods We retrospectively studied 16 patients (7 men, 9 women; mean age, 51 years) treated from January 2015 to December 2018. Motor vehicle accidents were the leading cause of injury. Types of fractures were pertrochanteric and shaft (6), pertrochanteric and distal (2), double shaft (3), neck and shaft (2), neck and distal (1), shaft and distal (1), and triple fracture including a pertrochanteric, shaft and distal (1). In five patients, two different implants were used (plate and screws, cannulated hip screws, femoral nail), whereas in 11 patients a long femoral nail was used. Results Fourteen patients experienced union at a mean of 3 months (2-6 months). Two patients experienced nonunion: both had plate and screws osteosynthesis. One patient died 15 days after admission from polytrauma and another patient experienced central venous catheter thrombosis and pneumonia. Surgical complications (2 patients) included a thigh skin necrosis, and external fixator pin tract infection/infected non-union. Weight-bearing was delayed in all patients; full weight-bearing was allowed in 11 patients at 4 months postoperatively, and in four patients at 5 months. Conclusion Due to the rarity and the difficulty of standardization of double ipsilateral femoral fractures, there is variable information on the optimal osteosynthesis of the fractures and the outcome of the patients. It seems that closed reduction and long hip nailing is the treatment of choice, with few complications.

The results of treatment of femoral diaphysis fractures using locked intramedullary osteosynthesis and extramedullary osteosynthesis (results for 10 years)

“…Не включены в данное исследование пациенты с двойным переломом бедренной кости, оперативное лечение которых производилось двумя способамиблокируемым интрамедуллярным имплантом и накостным остеосинтезом [13].…”

Comparison of reconstruction nails versus dual implants in the treatment of ipsilateral femoral neck and shaft fractures in adults: a meta-analysis and systematic review

“…Fractures involving the ipsilateral femoral neck and shaft are uncommon and comprise approximately 1% to 9% of all femur fractures [ 1 – 3 ]. These injuries typically result from high-energy trauma and are more common in young adult males who also sustain head, thoracic, abdominal and knee injuries [ 3 – 9 ], resulting in a considerable financial burden it on patients, families and health system.…”

“…Double fixation using two devices, i.e. the femoral shaft fracture is fixed with retrograde or anterograde intramedullary nail or plate, and the femoral neck fracture is fixed with cancellous screws or dynamic/sliding hip screws (DHS/SHS) [ 2 , 5 , 9 , 10 , 20 – 22 ].…”

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

“…Additionally, in comparison to isolated hip fractures, the complications of proximal fractures in concurrent fractures are lower. As the first point of impact is always the knee, they are often associated with injuries in and around the knee [7,9,11,12,[14][15][16].…”

“…Several case series have been published regarding the management of ipsilateral hip and femoral shaft fractures. Studies published in the last 15 years are summarized in Table3[6,7,11,[13][14][15][16][17][18][19]21,22,[25][26][27]. Some of the controversies in such fractures that remain to date are (i) single implant (cephalomedullary nail with or without additional screws) versus double implant (retrograde nail with DHS/CCS); (ii) order of fixation (whether hip fracture or shaft fracture should be fixed first); and (iii) acceptable reduction quality, especially in relation to the fractures of the femoral neck, and hence whether to use open reduction or closed reduction.…”