title: Accuracy of reduction of ipsilateral femoral neck and shaft fractures--an analysis of various internal fixation strategies.
abstract: OBJECTIVE
  Controversy surrounds the selection of the proper internal fixation device for treatment of ipsilateral fractures of the femoral neck and shaft. The purpose of this study was to review a large consecutive series of patients to learn more about the efficacy of various internal fixation strategies in maintaining an excellent reduction of both fractures.
  
  
  METHODS
  Retrospective multicenter.
  
  
  METHODS
  Two level 1 trauma centers.
  
  
  METHODS
  Between 1989 and 2006, 40 consecutive patients underwent internal fixation of an ipsilateral femoral neck and shaft fracture at 2 level 1 trauma centers. Thirty-seven of 40 patients (95%) with a mean age of 38 years (range, 18-73 years) had sufficient radiographs to assess accuracy of fracture reduction.
  
  
  METHODS
  Patients with displaced femoral neck fractures were typically treated with 2 separate devices and underwent formal open reduction of the femoral neck. Patients with nondisplaced neck fractures were treated with closed reduction and fixation with either 1 or 2 devices based on surgeon preference. The femoral neck fractures were displaced in 21 patients and nondisplaced in 16 patients. Nine fractures were addressed with a single implant and 28 with 2 separate devices.
  
  
  METHODS
  Radiographs were reviewed to evaluate the quality of reduction of both fractures. Clinical follow-up of 12 months or greater was available on 16 patients with a mean of 34.4 months (range, 12-112 months).
  
  
  RESULTS
  Thirty-six of 37 patients (97%) obtained or maintained excellent femoral neck reductions. The only poor neck reduction occurred in the case of a displaced femoral neck-shaft fracture treated with a single cephalomedullary implant. Thirty-five excellent (95%) and 2 poor shaft reductions were obtained. Both shaft malreductions occurred in comminuted shaft fracture patterns in which a single cephalomedullary device was used for both fractures. Performing internal fixation of both fractures with a single cephalomedullary device led to a significantly higher rate of fracture malreduction of one of the fractures (3 of 9) as compared with a 2-device strategy (0 of 28) (P = 0.01).
  
  
  CONCLUSIONS
  Open reduction and internal fixation of a displaced femoral neck fracture followed by retrograde nailing of the femoral shaft allowed accurate reduction and uneventful union of both fractures in most patients. The use of a cephalomedullary device to address both fractures simultaneously led to a significantly higher rate of malreduction of one of the fractures.
authors.affiliation: Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Asheesh
authors.initials: A
authors.lastname: Bedi
authors.forename: Madhav A
authors.initials: MA
authors.lastname: Karunakar
authors.forename: Troy
authors.initials: T
authors.lastname: Caron
authors.forename: Roy W
authors.initials: RW
authors.lastname: Sanders
authors.forename: George J
authors.initials: GJ
authors.lastname: Haidukewych