title: Injuries associated with femoral shaft fractures with special emphasis on occult injuries.
abstract: BACKGROUND
  Fractures of the femoral shaft are mostly the result of high-energy accidents that also cause multiple trauma injuries, in particular ipsilateral knee and hip injuries. The purpose of this study was to investigate the incidence of injuries associated with femoral shaft fractures and how many of them were undetected.
  
  
  METHODS
  We studied 148 patients (150 femoral shaft fractures) with an average age of 52 (range: 18-97). Femoral shaft fractures were treated with antegrade intramedullary nailing in 118 cases (78.7%), and with open reduction and internal fixation in 32 cases (21.3%). Unlocked reamed intramedullary nailing was performed in Winquist type I and type II fractures, while statically locked unreamed intramedullary nailing was carried out in Winquist type III and type IV fractures.
  
  
  RESULTS
  There were 70 patients with associated injuries (46.4%). The associated injuries went undetected in 18 out of 70 patients (25.5%). Six femoral nonunions (4%) occurred in patients under 70 years of age (high-energy accidents) treated by open reduction and internal fixation.
  
  
  CONCLUSIONS
  Injuries associated with femoral shaft fractures were very frequent (46.4%) in our series, with 25.5% undetected. Open reduction and internal fixation was a poor prognostic factor of nonunion in these fractures.
authors.affiliation: E. Carlos Rodriguez-Merchan MD, Luis Moraleda MD, Primitivo Gomez-Cardero MD, Department of Orthopaedic Surgery La Paz University Hospital, Paseo de la Castellana 261 28046-Madrid, Spain.
authors.forename: E Carlos
authors.initials: EC
authors.lastname: Rodriguez-Merchan
authors.affiliation: E. Carlos Rodriguez-Merchan MD, Luis Moraleda MD, Primitivo Gomez-Cardero MD, Department of Orthopaedic Surgery La Paz University Hospital, Paseo de la Castellana 261 28046-Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Moraleda
authors.affiliation: E. Carlos Rodriguez-Merchan MD, Luis Moraleda MD, Primitivo Gomez-Cardero MD, Department of Orthopaedic Surgery La Paz University Hospital, Paseo de la Castellana 261 28046-Madrid, Spain.
authors.forename: Primitivo
authors.initials: P
authors.lastname: Gomez-Cardero
keywords: Associated injuries; Diaphysis; Femur; Fracture; Treatment