title: Cephalomedullary nails in the management of ipsilateral neck and shaft fractures of the femur--one or two femoral neck screws?
abstract: This was a prospective study of 43 consecutive cases of combined ipsilateral femoral neck and shaft fractures treated with cephalomedullary nails. Sequential clinicoradiological evaluation of all high-energy femoral shaft fractures to detect associated ipsilateral neck fracture improved diagnosis. All but 1 of 35 cases included in the study achieved union of both fractures and excellent or good functional outcome. Mean Harris Hip Score at the last follow-up was 92+/-4 in single-neck screw configurations, and 94+/-3 for two-neck screw cephalomedullary nails which had better tip-apex distance. Mean sliding of the neck screw was 5+/-2mm with single-neck and 3+/-2mm with two-neck screw constructs. In six cases shortening was <1cm; 22 had delayed union of the shaft fracture, but only four of these needed additional surgery. Early aggressive fixation of both fractures using a cephalomedullary nail with the least possible surgical trauma is the key to success in these polytrauma cases.
authors.affiliation: Department of Orthopaedic Surgery, Manipal Hospital, Bangalore, 560 017, India. vidya007@gmail.com
authors.forename: S
authors.initials: S
authors.lastname: Vidyadhara
authors.forename: Sharath K
authors.initials: SK
authors.lastname: Rao
mesh_terms: D000328:Adult; D001858:Bone Nails; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005265:Femoral Neck Fractures / Q000000981:diagnostic imaging / Q000601:surgery; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D016896:Treatment Outcome