Treatment Evaluation of Concomitant Femoral Neck and Shaft Fractures (original) (raw)
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Case:A 23 year old female with 9 months of pregnancy sustained a injury on right thigh following a motor vehicle collision. Clinical examination demonstrated pain, swelling and deformity over the right thigh. X-ray was done and diagnosed as femoral shaft fracture right side. As patient was near date of delivery, decision was taken to do a caeserian section and wasdone immediately without delay. After 7 days of caeserian section interlock nailing was done for fracture femur. Probably, an undisplaced neck femur fracture was missed at that time which get displaced as patient gradually started weight bearing after 1 month of nail insertion. Later on neck femur fracture was fixed with " MISS-A-NAIL technique". Conclusion: Here we present the miss-a-nail technique that has shown good long term results in young active individuals.Rather than going for other techniques of fixation, cancellous screw fixation in a young patient with ipsilateral interlock nail in situ shows good long term results.
Use of Reconstruction Nail in The Treatment of Ipsilateral Femoral Neck and Shaft Fractures
2017
Objective: To determine the effectiveness of ipsilateral femur- neck shaft fracture fixation with reconstruction nail at a tertiary health care centre. Methods: This was a prospective observational study conducted from April 2014 to March 2016. Twenty-seven Patients were registered using a predesigned proforma. Inclusion criteria were either gender with age between 18 – 60 years with traumatic ipsilateral closed femur neck-shaft fracture. All patients registered subsequently underwent reconstruction nail insertion. The patients were followed in outpatient department after discharge at regular intervals to assess general recovery, complications and for assessment of fracture union. Results: All 27 patients achieved union of neck fracture in average duration of 127 days. All patients except one femur shaft fracture union achieved in mean duration of 250 days. 25 patients (i.e., 93%) had good functional status at the time of radiological union of shaft fracture while 2 (i.e., 7%) ha...
Reconstruction nailing for ipsilateral femoral neck and shaft fractures
Strategies in Trauma and Limb Reconstruction, 2011
The surgical management of ipsilateral fractures of the femoral neck and shaft presents a difficult and challenging problem for the orthopaedic surgeon. The purpose of the present study was to report the mid-term results and complications in a series of patients who sustained ipsilateral femoral neck and shaft fractures and treated in our trauma department with a single reconstruction nail for both fractures. Eleven patients were included in the study with an average age of 46.4 years. The mean follow-up was 47 months (range, 15-75 months). There were no cases of a missed diagnosis at initial presentation. The mean time to union was 4.5 months for the neck fracture and 8.2 months for the shaft. There were no cases of avascular necrosis of the femoral head or non-union of the neck fracture. The mean Harris Hip Score was (85 ± 4.3). Complications included two cases of shaft fracture non-union and one case of peroneal nerve palsy. Heterotopic ossification at the tip of the greater trochanter was evident in two cases without causing any functional deficit. The current study suggests that reconstruction nailing produces satisfactory clinical and functional results in the mid-term. The complications involved only the femoral shaft fracture and were successfully treated with a single operative procedure.
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.
Iatrogenic femoral neck fracture during closed nailing of the femoral shaft fracture
European Journal of Trauma and Emergency Surgery, 2009
Background: Intramedullary nails have become a popular implant in the management of femoral shaft fractures. The occurrence of a femoral neck fracture after closed intramedullary nailing is an exceptional complication of this technique that has been rarely reported in the literature. Methods: We report a retrospective study to identify the possible causes that could produce a fracture of the femoral neck after nailing of the ipsilateral femur. Results: A total of four neck fractures were identified in a series of 494 femoral shaft nailing, all of them not visible on the initial plain films. In two cases, the nail entry point was located lateral to the tip of the greater trochanter. In the other two cases, the entry point was located too medial to the greater trochanter, violating the superoexternal cortex of the femoral neck. Conclusion: The event of a femoral neck fracture during closed intramedullary nailing is an unusual complication that may be caused due to a technical mistake related to the location of the nail entry portal in the proximal femur.
Antegrade nailing of femoral shaft fractures combined with neck or distal femur fractures
Archives of Orthopaedic and Trauma Surgery, 2003
Introduction: Complex femoral fractures pose considerable therapeutic challenges to orthopedic surgeons. We present a retrospective review of 25 patients with complex femoral fractures treated with intramedullary locked nailing and supplemental screw fixation. Materials and methods: Fifteen patients with ipsilateral femoral neck and shaft fractures (group 1) and 10 patients with ipsilateral femoral shaft and distal femur fractures (group 2) were treated from 1990 to 1998. High-energy injuries occurred in all patients. There were 4 open fractures. Antegrade, locked nailing of diaphyseal fractures was performed in all cases. Supplemental screws for the neck were used in all patients in group 1 and in 3 patients in group 2. Results: All of the fractures united during the follow-up. Five patients in group 1 underwent reoperation (33.3%): one due to a delayed union, the second due to an implant failure, the third due to a nonunion of a neck fracture, and the last two because of an initially missed femoral neck fracture. None of the patients in group 2 underwent reoperation. Angular malalignment of the shaft was found in 6 fractures in group 1 (average 4.8 o , range 3 o-11 o) and in 4 fractures in group 2 (average 6 o , range 3 o-12 o). Shortening of the limb occurred in 3 patients in group 1 (average 1.4 cm, range 1-1.8) and in 1 patient in group 2 (2 cm). Loss of fixation was seen in 1 patient in each group. Avascular necrosis and infection were not seen in any case in both groups. Conclusion: Femoral intramedullary nails with antegrade or retrograde options for insertion and different locking possibilities have extended the indications to include both diaphyseal and metaphyseal fractures. New nail designs, usually more expensive than the conventional nails, have been introduced into the market for this purpose. One has to keep in mind that antegrade, locked nailing of femoral shaft fractures combined with neck or distal femur fractures is a technically demanding but efficacious procedure. The success rate is high when the technique is meticulously implemented.
Outcome Analysis of Ipsilateral Neck with Shaft of Femur Fractures Treated by Cephalomedullary Nail
Journal of Orthopedics and Joint Surgery, 2020
Background: The incidence of ipsilateral neck of femur with shaft of femur fracture was around 1-9%. The diagnosis of femoral neck fractures is frequently missed during the initial assessment due to more focus of femoral shaft fractures. There are hardly any literature regarding outcomes of ipsilateral neck and femur shaft fractures. The aim of the study is to assess the functional outcome of ipsilateral neck with shaft of femur fracture treated with cephalomedullary nail. Materials and methods: This is a prospective study done at Sri Ramachandra Medical College between April 2014 and December 2018 in the Department of Orthopedics. The inclusion criteria were patients above 18 years having ipsilateral neck with shaft of femur fracture. The exclusion criteria were isolated shaft or neck of femur fracture and patients who lost follow-up and open fractures. We had 15 patients who had full follow-up. The minimum follow-up was taken as 1 year. Patients' age group was between 24 years and 58 years with an average of 40 years. All the patients were followed up by modification of Wilde et al. 's Neer scoring system for outcome. Results: We had excellent results in five patients, seven patients had good results, and three patients had fair results. There was no poor result in our cases. In our study, 67% of the cases had no complications. The average time of union of the fracture was 25 weeks. Conclusion: Even though cephalomedullary nailing is technically demanding for ipsilateral neck of femur and shaft of femur fracture management, in our series with decent clinical outcome and fewer complications, it can be considered as an acceptable option in the management of these fractures.