title: A new classification and treatment protocol for combined fractures of the femoral shaft with the proximal or distal femur with closed locked intramedullary nailing: clinical experience of 63 fractures.
abstract: The medical records and radiographs of 63 patients, who were admitted between 1989-1997, with a combined femur fracture, were reviewed. Associated injuries were present in 38 (60%) patients. The combined fractures were classified into four major types depending on their anatomical position: type I, femoral shaft fracture combined with hip neck fracture; type II, femoral shaft fracture combined with a trochanteric fracture; type III, femoral shaft fracture combined with a distal femur fracture; and type IV, femoral shaft fracture combined with a proximal or distal femur fracture. The fractures were treated with locked intramedullary nailing and additional free cancellous 6.5-mm screws as needed. Fifty-six fractures healed without further operations. Of the remaining 6 fractures, 2 were material failures, 1 malunion with 3-cm shortening and external rotation of the femoral diaphysis, 2 early infections of the surgical wound, and 1 pseudarthrosis of the femoral shaft. All fractures were healed between 16 and 32 weeks (average: 20 weeks).
authors.affiliation: Orthopedic Clinic, Dept of Orthopedics, University of Patras, Rio-Patra Greece.
authors.forename: Elias
authors.initials: E
authors.lastname: Lambiris
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Giannikas
authors.forename: George
authors.initials: G
authors.lastname: Galanopoulos
authors.forename: Minos
authors.initials: M
authors.lastname: Tyllianakis
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Megas
mesh_terms: D001858:Bone Nails; D001863:Bone Screws; D005260:Female; D005264:Femoral Fractures / Q000145:classification* / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D015601:Injury Severity Score; D016268:Internal Fixators; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011859:Radiography; D020127:Recovery of Function; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome