Major trauma, definitive treatment of the lower limbs (original) (raw)
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Ipsilateral femoral neck and shaft fractures: a retrospective analysis of two treatment methods
Journal of Orthopaedics and Traumatology, 2008
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., reconstructiontype intramedullary nailing and various plate combinations. Materials and 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.
Ipsilateral femoral neck and shaft fractures: Retrospective study of 33 cases
Acta Orthopaedica, 1991
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., reconstructiontype intramedullary nailing and various plate combinations. Materials and 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.
European Journal of Orthopaedic Surgery and Traumatology, 2022
Background Combined ipsilateral femoral neck and shaft fractures are rare and present a challenging management dilemma. This study aims to assess the outcome of concomitant fixation of the ipsilateral femoral neck and shaft fracture using single versus dual surgical implants. Methods A single-center retrospective analysis of patients who underwent fixation of ipsilateral femoral neck and shaft fractures was performed over a 13-year period. Different techniques were employed to fix the complex injury. Both the reduction and the union time were assessed radiographically. Results A total of 36 patients with ipsilateral femoral neck and shaft fractures were retrospectively identified and included in the study. Twenty-four patients (66.6%) were managed with a single cephalomedullary nail, while the remaining cases were treated with two devices. All cases were operated on within an average of 3.7 ± 7.1 days. Eight patients (22.2%) developed postoperative complications. The average follow-up period was 7.3 ± 6.8 months. Although there was no statistically significant difference between the two groups, the femoral neck fractures showed shorter union time in patients treated with one implant compared to patients treated with two implants (3.0 ± 2.3 months vs. 4.2 ± 2.6 months). Another observation was that higher percentages of implant removal/failure and malunion/nonunion were seen in patients who had one implant compared to the two implants group (12.5% vs. 8.3%). Conclusion Early surgical fixation of both fractures is associated with good outcome results. No difference in outcome was observed between both groups.
Ununited ipsilateral femoral neck and shaft fractures: treatment of 16 patients
Archives of Orthopaedic and Trauma Surgery, 2004
Introduction: Ununited ipsilateral femoral neck and shaft fractures are very rare, and their treatment is very complicated. Until now, no single treatment method has been recommended in the literature. Materials and methods: Eighteen patients sustained femoral shaft fractures, which were treated with reamed intramedullary nails but remained ununited. Concomitant, ipsilateral femoral neck fractures were neglected for 2-16 months (median 4 months). The neck fractures were treated by subtrochanteric valgus osteotomy with sliding compression screw stabilization, and the shaft fractures by dynamic compression plating with supplementary cancellous bone grafting. Postoperatively, ambulation with protected weight-bearing was encouraged as early as possible. Results: Sixteen patients were followed up for at least 2 years (range 2-7 years), and all fractures healed. The neck fracture healed at 3.7±0.6 months (p<0.001), the osteotomy site at 5.3±0.9 months, and the shaft fracture at 5.6±1.0 months (p=0.07). All patients could walk without aids. Complications included one osteonecrosis of the femoral head (6.3%), which was followed up regularly without further treatment. Conclusion: The described technique provided a high union rate with a low complication rate. In addition, the surgical procedure was relatively simple. Therefore, it might be considered for all indicated cases.
Orthopedic Reviews, 2019
Concomitant ipsilateral femoral neck and shaft fractures are uncommon, occurring in 1-9% of femoral shaft fractures. While this injury typically occurs in young patients following high-energy trauma, little consensus has been established regarding the optimal fixation approach. A multitude of treatment strategies exist, with limited evidence as to which is more favorable. The aim of this study was to appraise current evidence, comparing management with either one single or separate devices for both fractures. A systematic review was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published between 1992 and 2018 comparing the rate of postoperative nonunion, malunion, delayed union, avascular necrosis, infection or reoperation between at least one method of single device fixation and one method of separate device fixation were included. Six non-randomized cohort studies assessing 173 patients were suitable f...
Treatment of ipsilateral femoral neck and shaft fractures
Life Science Journal, 2012
Background: No consensus exists regarding the optimal treatment of ipsilateral femoral neck and shaft fractures. We report our experience of managing 13 patients with ipsilateral femoral neck and shaft fractures by using either cannulated screws or dynamic hip screws for the neck and retrograde femoral nail for the shaft. The purpose of this study is to evaluate the function; outcome and healing of that complicated fractures. Material and methods: A consent was taken from thirteen patients who sustained ipsilateral femoral shaft and neck fractures from January 2007 and March 2011 in El Minoufiya University Hospital in Egypt. 10 patients with fracture neck femur had been treated with cannulated screws while 3 patients were treated by dynamic hip screw. all fractures shaft had been treated with retrograde femoral nail.. The mean follow up period was 18 months with range from 12-36 months. Results: There were 10 males and 3 females. The average age was 31 years old with range of 19-45years. The mean follow up period was 18 months with range from 12-36 months. The average healing period of femoral neck fracture was 14 weeks and all femoral neck fractures united. Average union time for femoral shaft fractures was 19 weeks (range, 16-36 weeks). Three femoral shaft fractures needed bone graft at six months. Conclusions: The treatment methods used in the present study achieved satisfactory functional outcome in these complex fractures. The femoral neck fracture should preferably be stabilized first. [Mohamed E. Habib, Yasser S. Hannout and Ahmed F. Shams. Treatment of ipsilateral femoral neck and shaft fractures.
Ipsilateral fractures of the femoral neck, shaft and distal end: long-term outcome of five cases
International Orthopaedics, 2011
Out of 52 cases of ipsilateral femoral fractures treated at a level I trauma centre between June 1994 and March 2008, the diaphyseal fracture was accompanied by a intracapsular neck fracture in only 20 cases. In the rest of the cases, the diaphyseal fracture was combined with either an extracapsular or pertrochanteric fracture. Five of these patients also had fractures of the distal femur. In three of those patients we began treatment with osteosynthesis of the femoral neck and shaft, using a reconstruction nail, then stabilised the distal fracture with a 95°blade plate or with lag screws. In the other two cases, initial treatment dealt with the distal femoral fracture, fixing it with a 95°blade plate, which was also used for stabilisation of the diaphyseal fracture. In these patients, the proximal fracture was treated using dynamic hip screws (DHS). All fractures healed, two after initial treatment, while the other three needed one revision. The follow-up period was 2-13 years after the injury. The order in which fractures are treated is best left to the discretion of the physician and the circum-stances. In our experience, two implants are sufficient for osteosynthesis, one for stabilising one end of the femur together with the shaft, and the other is used for treating the other end of the femur.