Ipsilateral hip and femoral shaft fractures treated with intramedullary nails

Abstract

This study retrospectively analysed 34 patients with ipsilateral hip and femoral shaft fractures treated over a period of 10 years between January 1995 and January 2005. They had an average age of 35 years. Twenty-six (76.47%) of these cases suffered high-velocity trauma (RTA); six others had fallen from a height (17.65%), and two had suffered only minimal trauma (5.88%). Twenty were extracapsular (58.82%) and 14 were intracapsular. They were evaluated with an average follow-up of 28 months, both clinically and radiologically; 26 patients (76.47%) had a good result (Friedman and Wyman score). When the intracapsular fracture was detected postperatively, there was one delayed union and one non-union. When the fracture is diagnosed preoperatively, we recommend reconstruction nail fixation. If the hip fracture is diagnosed intra-or postoperatively following nailing of the shaft, we propose the miss-a-nail technique as an option. Résumé

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.…”

“…[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.…”

A comparative study of ipsilateral intertrochanteric and femoral shaft fractures treated with long proximal femoral nail antirotation or plate combinations

“…The treatment of this combination of fractures remains a challenge to surgeons. Surgical stabilization with implants is the preferred treatment method for ipsilateral intertrochanteric and femoral shaft fractures, according to most published reports 1–3,5,6 .…”

“…A meta‐analysis showed plate combinations had a high incidence of infection and non‐union, whereas unlocked intramedullary nail fixation was complicated by rotary malalignment and shortening 1 . The advantages of closed treatment of fractures with intramedullary nails have been well documented 1,5,6,9 . However, technical complications are encountered in reconstruction nailing, and a high incidence of nonunion and complications related to the knee occur with retrograde nailing 6,9–11 .…”

Comment on Shetty et al.: Ipsilateral hip and femoral shaft fractures treated with intramedullary nails

“…The topic was nicely described [1]. The treatment of ipsilateral fracture poses a challenging task for planning surgery with intra-operative and post-operative complications including, most devastating of all, non-union of fractured neck of femur.…”