Treatment for ipsilateral fractures of femoral neck and shaft.
BACKGROUND
Concomitant ipsilateral femoral shaft and neck fractures present a challenge to the orthopaedic surgeon, and no consensus has yet emerged on the optimal treatment method. We report the results of a retrospective study of 43 patients with these complex fractures who were treated at a single Level 1 trauma centre.


METHODS
The study participants consisted of 28 males and 15 females with a mean age of 43 years. The mean follow-up period was 48 months. Four different treatment methods were used: (1) antegrade reamed intramedullary nailing of the shaft with cancellous screw fixation of the neck, (2) dynamic hip screw (DHS) fixation of the neck and low-contact dynamic compression plate (LCDCP) fixation of the shaft, (3) cancellous screw fixation of the neck and LCDCP fixation of the shaft, and (4) reconstruction nailing of both shaft and neck.


RESULTS
No statistically significant differences in amount of blood loss, duration of surgery, total complication rate, nor clinical results were found among the four treatment methods. For femoral neck fracture, however, the complication rate of cannulated screw with antegrade intramedullary nailing fixation was 11 times that of DHS with LCDCP fixation.


CONCLUSIONS
Antegrade nail with screw fixation is not a recommended treatment method in patients with ipsilateral femoral shaft and neck fractures.
Tsai
Chun-Hao
CH
Department of Orthopaedic Surgery, China Medical University Hospital,Taichung, Taiwan, ROC. ritsai8615@gmail.com
Hsu
Horng-Chaung
HC
Fong
Yi-Chin
YC
Lin
Cheng-Jyh
CJ
Chen
Ying-Hao
YH
Hsu
Chin-Jung
CJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D057210:Delayed Diagnosis; D005260:Female; D005264:Femoral Fractures / Q000145:classification / Q000601:surgery*; D005265:Femoral Neck Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019919:Prosthesis Implantation / Q000379:methods*; D011859:Radiography; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D014193:Trauma Centers; D016896:Treatment Outcome; D055815:Young Adult