Nine patients had a femoral shaft fracture in the middle third, one in the proximal third and two in the distal third. Ten patients had Garden type II and two had Garden type III fractures. Ten patients had basicervical, one had transcervical, and one had subcapital femoral neck fractures. Mean age was 37.9 years (range, 22–51 years SD, 11.6 years). Group II included 12 patients (11 males and 1 female) who were operated with reconstruction-type intramedullary nailing. As per AO classification, three fractures were type 32A, seven were 32B, and five fractures were 32C. According to the Hansen–Winquist classification, three of the diaphyseal fractures were type I, seven were type II, one was type III, and four were type IV. Eleven patients had femoral shaft fracture in the middle third and four had it in the distal third. Thirteen patients had Garden type II and two had Garden type III fractures. Thirteen patients had basicervical and two had transcervical femoral neck fractures. Mean age was 33.2 years (range, 22–45 years SD, 6.2 years). Group I included 15 patients (13 males and 2 females) who were operated with cancellous lag screws or DHS for fractured neck and compression plate fixation for fractured shaft of the femur. We divided patients into two groups (Table 1). None of the patients had open or pathological fracture. Thirteen patients had injuries to other parts, viz. All patients were injured after high-energy trauma in road traffic accidents. This retrospective study reports our experience of managing 27 patients with ipsilateral femoral neck and shaft fractures using two different treatment methods, i.e., reconstruction-type intramedullary nailing and various plate combinations, in order to address these three key issues.īetween January 2000 and December 2006, we treated 27 patients with ipsilateral femoral neck and shaft fractures. The three major issues related to these fractures are optimal timing of surgery, which fracture to stabilize first, and the optimal implant to use. No consensus exists regarding the optimal treatment of these complex fractures. Each method has its own advantages and disadvantages. Treatment options include: (1) antegrade femoral nailing of the shaft with cancellous screws placed anterior to the nail for fixation of the neck (2) reconstruction-type intramedullary nailing (3) various plate combinations (4) retrograde intramedullary nailing of the shaft and screw fixation of the neck. The treatment of ipsilateral femoral neck and shaft fractures is difficult, and there are many protocols for the management of these fractures. The diagnosis of the neck fracture is delayed in 19–31% of patients. Victims are usually young, with multiple associated injuries. Most are encountered in high-energy trauma. Ipsilateral femoral neck and shaft fractures occur in 2.5–9% of femur fractures. The femoral neck fracture should preferably be stabilized first, and a delay of 5–6 days does not affect the ultimate functional outcome. 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. Fixation with plate for shaft and screws or DHS for hip is easy from a technical point of view. Conclusionsīoth of the treatment methods used in the present study achieved satisfactory functional outcome in these complex fractures. There were 10 (83.3%) good, 1 (8.3%) fair and 1 (8.3%) poor functional results in group II. There were 13 (86.6%) good, 1 (6.7%) fair and 1 (6.7%) poor functional results in group I. 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. Mean delay in surgery was 5.9 and 5.4 days in group I and II, respectively. Mean age was 33.2 and 37.9 years in group I and II, respectively. 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. 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. 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. No consensus exists regarding the optimal treatment of ipsilateral femoral neck and shaft fractures.
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