Ipsilateral femoral neck and shaft fractures: Retrospective study of 33 cases (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.
Treatment Evaluation of Concomitant Femoral Neck and Shaft Fractures
Journal of Rawalpindi …, 2012
Background: To evaluate the results of fixation of fracture neck of femur associated with fracture shaft of femur, by reconstruction nail or lag screws with conventional nail system. Methods: In this descriptive study, 22 patients, with ipsilateral femoral neck and shaft fracture were included. Reconstruction nails were used in 16 cases and cancellous lag screws in 06 cases, where femur had been already fixed with k nail and interlocking nail. Results: Majority (90.9%) were male. Complex fracture of femoral shaft and neck was seen in 72.72%. In majority (81.81%) %) type II Gorden Fracture took place.Patients were mobilized on crutches on second day of surgery and were not allowed weight bearing till union of neck of femur. No case of avascular necrosis or non union of neck fracture was noted. Conclusion: Reduction of neck fracture is the key factor for good outcome. Patients with complex fractures requires minimally invasive techniques. There should be lesser soft tissue dissection to prevent complications. Where reconstruction nail is not possible two to three lag screws with good reduction of neck of femur has satisfactory results.
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.
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.
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.
Management of femoral neck fractures
Femoral neck fractures are the second most common non-vertebral fragility fracture, and their management is complicated by multiple controversies. This article aims to review the recent literature in an attempt to elucidate current concepts critical to the management of intra-capsular femoral neck fractures. The optimal timing of surgery remains controversial. A recent meta-analysis was able to show that a delay of longer than 24–72 hours resulted in a statistically significant increase in mortality. Internal fixation of undisplaced fractures remains undisputed. In terms of displaced fractures, two well-designed studies have shown significantly higher re-operation rates in patients treated with closed reduction and internal fixation. While there appears to be renewed interest in the use of bi-polar hemiarthroplasty, conflicting evidence has been published with regard to total hip replacement for hip fractures in the elderly, and it may only be indicated in selected subgroups of rela...
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.
Management of Femoral Neck Fracture Treated with Dynamic Hip Screw and Bone Grafting
Orthopedics and Sports Medicine Open Access Journal, 2020
Objective: To evaluate the outcome of fracture neck of femur treated with dynamic hip screw and bone graft in term of union. Material and Methods: This Descriptive case series study was carried out in the Orthopaedics Department, Lady Reading Hospital Peshawar from June 2018 to December 2018 on 153 patients of age 50 and above. Patient were put on traction table and closed reduction of the fracture was done with the help of image intensifier. Lateral transgluteal incision (Hardinges incision) was given. Dynamic Hip Screw was done on inferiomedial guide wire while only drilling was done to make a 9mm wide hole on the superiorly placed guide wire and Bone grafts taken from same side iliac crest was placed in it. Wound was closed in layers and antiseptic dressing was done. Follow up was done with serial x-rays (AP & lateral views) regularly every 4 weeks till fracture union & nonunion at 3 rd months was declared using Radiological Union Score for Hip. Results: In this study mean age was 41.9 years with SD ± 11.72. Seventy-two percent patients were male while 28% patients were female. Moreover 85% patients had fracture union while15% patients no fracture union. Conclusion: Our study concludes that frequency of fracture union was 85% in fracture neck of femur treated with dynamic hip screw and bone graft.
The Journal of the American Academy of Orthopaedic Surgeons, 2008
During the past 10 years, there has been a worldwide effort in all medical fields to base clinical health care decisions on available evidence as described by thorough reviews of the literature. Hip fractures pose a significant health care problem worldwide, with an annual incidence of approximately 1.7 million. Globally, the mean age of the population is increasing, and the number of hip fractures is expected to triple in the next 50 years. One-year mortality rates currently range from 14% to 36%, and care for these patients represents a major global economic burden. Surgical options for the management of femoral neck fractures are closely linked to individual patient factors and to the location and degree of fracture displacement. Nonsurgical management of intracapsular hip fractures is limited. Based on a critical, evidence-based review of the current literature, we have found minimal differences between implants used for internal fixation of displaced fractures. Cemented, unipol...