Single versus separate implant fixation for concomitant ipsilateral femoral neck and shaft fractures: A systematic review

Abstract

Concomitant ipsilateral femoral neck and shaft fractures are uncommon, occurring in 1-9% of femoral shaft fractures. While this injury typically occurs in young patients following high-energy trauma, little consensus has been established regarding the optimal fixation approach. A multitude of treatment strategies exist, with limited evidence as to which is more favorable. The aim of this study was to appraise current evidence, comparing management with either one single or separate devices for both fractures. A systematic review was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published between 1992 and 2018 comparing the rate of postoperative nonunion, malunion, delayed union, avascular necrosis, infection or reoperation between at least one method of single device fixation and one method of separate device fixation were included. Six non-randomized cohort studies assessing 173 patients were suitable for inclusion, each comparing single device cephalomedullary nail fixation of both fractures with a combination of devices. All patients presented following high-energy trauma, at a median age of 32 years. While low complication rate and favorable outcomes were found across both groups, no significant difference could be inferred between either treatment strategy. This injury continues to occur in the traditionally described patient group, and results in acceptable postoperative outcomes. A paucity of randomized studies limits the ability to recommend a single or separate device treatment approach, and as such prospective, randomized trials with adequately powered sample sizes are required to definitively compare surgical management strategies in this rare but complex injury.

The rendezvous technique for the treatment of ipsilateral femoral neck and shaft fractures: A case series

“…Boulton et al in a 2014 systematic review, indicated their preference for a dual implant, femoral neck fracture first approach [ 5 ]. A more recent systematic review, found favorable outcomes in both treatment groups, and called for prospective, randomized trials to definitively guide treatment strategy [ 8 ].…”

“…We chose a dual construct, stabilizing the femoral shaft fracture first with a RFN and then using a DHS in an overlapping configuration, to treat the femoral neck fracture, the so-called “rendezvous” technique [ 8 ].…”

“…In these instances the use of damage control orthopedics (DCO) is recommended. In those cases the femoral shaft can be promptly stabilized with an un-reamed RFN, this will reduce pain, blood loss and allow for easier nursing care, allowing time for the patient's general condition to improve, at which time the femoral neck fracture can be treated with a DHS [ 8 ]. The use of a single CMN in these circumstances is likely to result in longer operating times and increased blood loss, as well as compromised reduction at one or both fracture sites [ 11 , 13 ].…”

Femoral Neck Nonunion Associated With Delayed Union of Ipsilateral Femoral Shaft Fracture

“…Concomitant ipsilateral femoral shaft and neck fractures usually result from high-velocity injuries in young patients [1][2][3]. The incidence of these injuries is approximately 1% to 9% of all femoral shaft fractures [4,5]. In polytraumatized patients, these injuries are often missed and delayed diagnoses are common as the femoral neck fracture pattern is either undisplaced or minimally displaced.…”

Salvaging Chronic Nonunion of Femoral Neck and Infected Nonunion of Ipsilateral Femoral Shaft Fracture Using Intramedullary Antibiotic Cement Spacer and External Fixator Alone

“…Additionally, due to the inherent instability of this fracture pattern, the fixation may fail prior to the achievement of fracture union. Infected nonunion of fracture is another entity that frequently complicates the fracture healing process [ 2 ]. The management of infected fracture nonunions has never been simple, and often requires staged management in the form of infection control measures followed by the definitive fixation.…”