title: Noncontiguous fractures of the femoral neck, femoral shaft, and distal femur.
abstract: BACKGROUND
  Multifocal fractures of the femur are uncommon injuries and present unique management challenges. Combined ipsilateral fractures of the femoral shaft and femoral neck or the femoral shaft and distal femur have been described. The combination of noncontiguous ipsilateral femoral neck, femoral shaft, and distal femoral articular injuries, however, has not been described. The purposes of this report are to document the incidence and characteristics of this injury and to present a treatment rationale.
  
  
  METHODS
  This was a retrospective study conducted at a Level I trauma center.
  
  
  RESULTS
  Over a 5-year period, 1639 adult patients with femur fractures were definitively managed at the authors' institution. Five male and two female patients (average age, 43.3 years) sustained ipsilateral, noncontiguous fractures of the femoral neck, femoral shaft, and distal femoral articular surface (0.43%). All femoral neck fractures were vertically oriented. All distal femoral injuries were unicondylar. A variety of fixation methods were used, dependent on individual fracture characteristics. The femoral neck fractures were prioritized in all cases. Stabilization of the distal femoral articular surface was then performed before diaphyseal fixation in patients with sagittally oriented condylar fractures. Patients were followed for an average of 19.3 months. All fractures healed without the need for secondary procedures.
  
  
  CONCLUSIONS
  This injury constellation is rare. Open reduction and internal fixation of the displaced femoral neck fracture should be the primary focus of orthopedic management, followed by stable reduction and fixation of displaced distal femoral articular injuries. The diaphyseal fracture should be treated with a technique that does not jeopardize either the proximal or the distal fractures. Patients who are critically ill can be managed in a similar sequence over the course of several days, depending on their overall condition.
authors.affiliation: Department of Orthopaedic Surgery, Harborvieew Medical Center, Seattle, Washington 98104, USA.
authors.forename: David P
authors.initials: DP
authors.lastname: Barei
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Schildhauer
authors.forename: Sean E
authors.initials: SE
authors.lastname: Nork
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D005260:Female; D005264:Femoral Fractures / Q000145:classification / Q000150:complications* / Q000601:surgery; D005265:Femoral Neck Fractures / Q000145:classification / Q000150:complications* / Q000601:surgery; D005592:Fracture Fixation / Q000379:methods*; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D011859:Radiography; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data; D014861:Washington / Q000453:epidemiology