title: Treatment of ipsilateral concomitant fractures of proximal extra capsular and distal femur.
abstract: OBJECTIVE
  Ipsilateral concomitant fractures of proximal extracapsular and distal femur are rare injuries and pose a great challenge for orthopaedics. In this study, we reviewed and examined the approaches and outcomes of this complex injury.
  
  
  METHODS
  From August 2002 to January 2010, seven patients (six males and one female) with a mean age of 39 years (range, 20-48 years) were involved in the study. They had suffered from ipsilateral concomitant fractures of proximal extracapsular and distal femur, with two cases of unstable intertrochanteric fractures, three cases of subtrochanteric fractures and two cases of extracapsular femoral neck fractures. The distal femoral fractures were categorised based on the Arbeitsgemeinschaft für Osteosynthes (AO) classification: 2, A3; 2, C1; 2, C2 and 1, C3, and the proximal femoral fractures were stabilised via nailing, whilst the distal ones via less-invasive stabilisation system-distal femur (LISS-DF) plating in all six patients. In the one with the 'floating knee' injury, the subtrochanteric fracture was stabilised by reversed LISS-DF, and the distal one, by retrograde nailing. The healing of each femoral fracture was evaluated radiologically and clinically with follow-up. The functional outcomes were assessed through the Friedman and Wyman system.
  
  
  RESULTS
  The mean follow-up interval was 2 years (range, 1.5-3 years). Six femoral fractures healed uneventfully, whilst the one with the 'floating knee' injury developed a delayed union postoperatively due to metal failure in 6 months, and, eventually, a malunion with coxa vara deformity 1.5 years later. The clinical functions at the final follow-up were found to be good in five cases, and fair and poor in one case each.
  
  
  CONCLUSIONS
  The nailing of a proximal femoral fracture and an LISS-DF fixation of a distal one could be a reliable and effective approach to handle ipsilateral concomitant fractures of a proximal extracapsular and distal femur.
authors.affiliation: Department of Orthopaedics, Shanghai First People's Hospital, Shanghai Jiaotong University, 100 Haining Rd., Hongkou District, Shanghai, China. gaokanda@sina.com.cn
authors.forename: Kanda
authors.initials: K
authors.lastname: Gao
authors.forename: Wei
authors.initials: W
authors.lastname: Gao
authors.forename: Fan
authors.initials: F
authors.lastname: Li
authors.forename: Jie
authors.initials: J
authors.lastname: Tao
authors.forename: Jianhua
authors.initials: J
authors.lastname: Huang
authors.forename: Haoqing
authors.initials: H
authors.lastname: Li
authors.forename: Qiugen
authors.initials: Q
authors.lastname: Wang
mesh_terms: D000328:Adult; D001858:Bone Nails; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult