Ipsilateral proximal and shaft femoral fractures

Abstract

PurposeTo study the management and evaluate anatomical and functional outcomes of patients with ipsilateral proximal and shaft femoral fractures.MethodsA retrospective, descriptive and analytic study lasted for ten years and a half ranging from January 1, 2005 to June 30, 2015. The following parameters were studied: epidemiology, fracture characteristics, therapeutic, anatomical and functional outcomes. The correlation between different parameters was analyzed with Fischer test. The significant threshold was defined for p value <0.05.ResultsTen medical files were registered. There were 7 men and 3 women, with a sex ratio of 2.33. The average age was 46 years (range: 29–62 years). It was about traffic road accidents in all cases. Motorcycle–motorcycle and motorcycle–car collision were most frequent. Average admission delay was 7 h (range: 1.5–24 h). Left side was most reached in 8 cases. According to Garden classification, there was type III cervical fracture in 2 cases, type II in 1 case and type IV in 1 case. According to Ender classification, there was type I trochanteric fracture in 3 cases, type VI in 2 cases and type VII in 1 case. According to AO classification, there was type A shaft fracture in 6 cases (A2 in 4 cases and A3 in 2 cases), type B in 2 cases (B1 in 1 case and B2 in 1 case) and type C in 2 cases (C1 in 1 case and C2 in 1 case). Average surgical delay was 28.7 days (range: 11–61 days). For proximal femoral fracture, Moore prosthesis was used in 1 case, blade plate 130° in 2 cases, long Gamma nail in 4 cases, double screwing in 2 cases and dynamic hip screw in 1 case. For shaft femoral fracture, blade plate 95° was used in 3 cases, low compressive plate in 2 cases. Osseous contention was achieved in 4 cases with long Gamma nail and in 1 case with long blade plate 130°. Nonunion of cervical fracture was achieved in 2 cases. The average osseous healing delay was 5.14 months (range: 3–12 months) for proximal femoral fracture and 5 months (range: 3–8 months) for shaft femoral fractures. According to Friedman and Wyman criteria, functional results were good in 4 cases, average in 4 cases and bad in 2 cases. Regarding implants, healing delay showed no statistic difference between one-implant group and two-implant group (p = 0.52), and among the patients with different functional outcomes (p = 0.52). Functional outcomes showed no statistic difference between one-implant group and two-implant group (p = 0.46).ConclusionIpsilateral proximal and shaft femoral fractures are relatively uncommon in our daily activities. It is difficult to recognize proximal femoral fractures which are unnoticed. Results are generally good if the doctors take the two fractures into account in the management.

Ipsilateral proximal and shaft femoral fractures treated with bridge-link type combined fixation system

“…The purpose of ipsilateral proximal and shaft femoral fracture surgical management is to achieve the anatomical reduction of the proximal femoral fracture and rigid fixation of both fractures. Studies have recommended that the operation be performed within 8 h, 12 h, 24 h, 72 h, or 1 week [ 9 , 25 – 27 ]. It is generally accepted that early surgical treatment can reduce patient complications and morbidity and allow for earlier functional exercise and rehabilitation.…”

“…Various constructs and surgical techniques have been described for the treatment of ipsilateral proximal and shaft femoral fractures, including single constructs or dual constructs for both fractures [ 4 , 6 , 7 , 25 , 29 , 30 ]. Single constructs include reconstruction intramedullary nails with interlocked screw fixation for the neck fracture via the nail, long proximal femoral nails (PFN-long) with anti-rotation, long sliding hip screws, and long proximal femoral locking plates [ 7 , 9 , 20 ].…”

Ipsilateral Proximal and Shaft Femoral Fractures Treated With Bridge-Link type combined fixation system

“…The purpose of ipsilateral proximal and shaft femoral fracture surgical management is to achieve anatomical reduction of the proximal femoral fracture and rigid xation of both fractures. Studies have recommended that the operation be performed within 8 h, 12 h, 24 h, 72 h, or 1 week [9,[25][26][27]. It is generally accepted that early surgical treatment can reduce patient complications and morbidity and allow for earlier functional exercise and rehabilitation.…”

“…Various constructs and surgical techniques have been described for the treatment of ipsilateral proximal and shaft femoral fractures, including single constructs or dual constructs for both fractures [4,6,7,[29][30][31]. Single constructs include reconstruction intramedullary nails with interlocked screw xation for the neck fracture via the nail, long proximal femoral nails (PFN-long) with anti-rotation, long sliding hip screws, and long proximal femoral locking plates [7,9,20].…”

Tratamento de fraturas ipsilaterais da diáfise e do colo do fêmur com implante único

“…A incidência das fraturas do fêmur proximal aumentou, significativamente, nas últimas décadas, devendo duplicar nos próximos 25 anos devido ao aumento da esperança média de vida 1 . Com o aumento dos traumas decorrentes de acidentes automobilísticos, esse padrão de fratura também ganhou destaque na população mais jovem, principalmente associado a outras fraturas, como a diafisária do fêmur ipsilateral 2 .…”