Ipsilateral femoral neck and shaft fractures: a retrospective analysis of two treatment methods

Abstract

Background No consensus exists regarding the optimal treatment of ipsilateral femoral neck and shaft fractures. The three major issues related to these fractures are the optimal timing of surgery, which fracture to stabilize first, and the optimal implant to use. In an effort to find answers to these three key issues, we report our experience of managing 27 patients with ipsilateral femoral neck and shaft fractures by using two different treatment methods, i.e., reconstructiontype intramedullary nailing and various plate combinations. Materials and methods We divided patients into two groups. Group I included 15 patients (13 males and 2 females) who were operated with cancellous lag screws or dynamic hip screws (DHS) for fractured neck and compression plate fixation for fractured shaft of the femur. Group II included 12 patients (11 males and 1 female) who were operated with reconstruction-type intramedullary nailing. Results Mean age was 33.2 and 37.9 years in group I and II, respectively. Mean delay in surgery was 5.9 and 5.4 days in group I and II, respectively. Average union time for femoral neck fracture in groups I and II were 15.2 and 17.1 weeks, respectively; and for shaft fracture these times were 20.3 and 22.8 weeks, respectively. There were 13 (86.6%) good, 1 (6.7%) fair and 1 (6.7%) poor functional results in group I. There were 10 (83.3%) good, 1 (8.3%) fair and 1 (8.3%) poor functional results in group II.

Femoral lock plant alone for ipsilateral subtrochanteric, supracondylar, and intercondylar fracture

“…The majority of the patients are encountered in high-energy trauma. 10,9 Without doubt these fractures are best managed by surgical stabilisation. Although many methods of fixation have been tried to manage this injury, there is often more than one internal fixations system were needed for these fractures.…”

Ipsilateral proximal and shaft femoral fractures

“…Surgical delay was long in our study since recommendations in literature indicated cervical fixation which varied from one day to a week 16, 17. Most authors recommended a prompt management with priority given to reduction and stabilization of cervical fracture 1, 3, 4, 10, 16, 18, 19. Someone advocated giving shaft fixation firstly so that reducing proximal fracture would be easier 20, 21, 22.…”

Analysis of the results of ipsilateral hip and shaft femur fractures treated with reconstruction-type intramedullary nail or various plate combinations

“…Though recent literature shows favourable results with the use of a single implant i.e., reconstruction type of intramedullary nail, we are of the opinion that treating these combination of fractures with two separate devices (plate-screw combinations) does have a role. [7][8][9][10][11][12][13][14][15] In this study we compared the outcome of ipsilateral hip and shaft femur fractures treated with reconstruction-type intramedullary nailing and various plate combinations on the fracture healing and functional outcome in patients. Very few authors have compared these two methods of fixation.…”

“…Very few authors have compared these two methods of fixation. 13,14 Femoral neck fracture is unrecognized in the initial examination of 19-31% of patients.…”

“…[7][8][9][10][11][12][13][14][15]  Various plate-screw combinations-including a dynamic hip screw (DHS) and long side plate combination, a hip screw with a short side plate for the neck and separate plate for the shaft or cancellous screws for femoral neck and a plate for the shaft. 13,14,16  Retrograde intramedullary nail of the shaft and screw fixation of the neck. [17][18][19]  Antegrade femoral nailing of the shaft with separate screws adjacent to the nail for fixation of neck ('miss-a-nail' technique).…”