title: Midshaft femoral fracture, concomitant ipsilateral hip joint injury, and disruption of the knee extensor mechanism: a unique triad of dashboard injury.
abstract: Our experience with 10 patients who suffered midshaft fractures of the femur and injuries to their ipsilateral hips has resulted in a treatment protocol that we believe can avoid unnecessary complications. The surgical protocol is a three-stage procedure based on (1) intramedullary nailing of the femur with interlocking for preserving the anatomic length and rotation of the femur; (2) treatment of the hip joint injury by means of open reduction and internal fixation of the acetabular fracture and/or reduction and fixation of the fractured femoral neck; and (3) repair of the extensor mechanism. Eight patients received this treatment and had fast recoveries. Union of the femoral fracture and full range of motion of the knee joint were observed within 3 months. In contrast, two patients who had received different surgical treatment had incomplete functional recoveries. This study offers a treatment protocol for ipsilateral disruption of the extensor mechanism, hip joint injury, and midshaft fracture of the femur in the multiply injured patient that can achieve full recovery with no complications. This relatively rare combination of injuries is definitely worthy of special attention.
authors.affiliation: Department of Orthopedic Surgery, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Mosheiff
authors.forename: D
authors.initials: D
authors.lastname: Segal
authors.forename: R
authors.initials: R
authors.lastname: Wollstein
authors.forename: S
authors.initials: S
authors.lastname: Sagiv
authors.forename: M
authors.initials: M
authors.lastname: Liebergall
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D002985:Clinical Protocols; D005260:Female; D005264:Femoral Fractures / Q000503:physiopathology / Q000601:surgery*; D005592:Fracture Fixation / Q000379:methods; D025981:Hip Injuries; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007718:Knee Injuries / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D012720:Severity of Illness Index