title: Ipsilateral femoral neck and shaft fractures: a retrospective analysis of two treatment methods.
abstract: BACKGROUND
  No consensus exists regarding the optimal treatment of ipsilateral femoral neck and shaft fractures. The three major issues related to these fractures are the optimal timing of surgery, which fracture to stabilize first, and the optimal implant to use. In an effort to find answers to these three key issues, we report our experience of managing 27 patients with ipsilateral femoral neck and shaft fractures by using two different treatment methods, i.e., reconstruction-type intramedullary nailing and various plate combinations.
  
  
  METHODS
  We divided patients into two groups. Group I included 15 patients (13 males and 2 females) who were operated with cancellous lag screws or dynamic hip screws (DHS) for fractured neck and compression plate fixation for fractured shaft of the femur. Group II included 12 patients (11 males and 1 female) who were operated with reconstruction-type intramedullary nailing.
  
  
  RESULTS
  Mean age was 33.2 and 37.9 years in group I and II, respectively. Mean delay in surgery was 5.9 and 5.4 days in group I and II, respectively. Average union time for femoral neck fracture in groups I and II were 15.2 and 17.1 weeks, respectively; and for shaft fracture these times were 20.3 and 22.8 weeks, respectively. There were 13 (86.6%) good, 1 (6.7%) fair and 1 (6.7%) poor functional results in group I. There were 10 (83.3%) good, 1 (8.3%) fair and 1 (8.3%) poor functional results in group II.
  
  
  CONCLUSIONS
  Both of the treatment methods used in the present study achieved satisfactory functional outcome in these complex fractures. Fixation with plate for shaft and screws or DHS for hip is easy from a technical point of view. Choice of the treatment method should be dictated primarily by the type of femoral neck fracture and the surgeon's familiarity with the treatment method chosen. The femoral neck fracture should preferably be stabilized first, and a delay of 5-6 days does not affect the ultimate functional outcome.
authors.affiliation: Department of Orthopaedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma PGIMS, 9-J/52, Medical Enclave, Rohtak, 124001, Haryana, India, drroopsingh@rediffmail.com.
authors.forename: Roop
authors.initials: R
authors.lastname: Singh
authors.forename: Rajesh
authors.initials: R
authors.lastname: Rohilla
authors.forename: Narender Kumar
authors.initials: NK
authors.lastname: Magu
authors.forename: Ramchander
authors.initials: R
authors.lastname: Siwach
authors.forename: Virender
authors.initials: V
authors.lastname: Kadian
authors.forename: Sukhbir Singh
authors.initials: SS
authors.lastname: Sangwan