Skip to main content
SpringerLink
Log in

Orthopaedic Implant Fixation Strategies for Multiple Fractures in a Single Bone

  • Reference work entry
  • First Online:
Handbook of Orthopaedic Trauma Implantology

  • 32 Accesses

Abstract

The management of multiple fractures in a single bone can be challenging for orthopaedic surgeons due to the complexity of the injury and the potential for complications. In this chapter, we review the various implant fixation strategies available for managing these injuries, including internal fixation with plates, screws, and nails, as well as external fixation with pins and wires. We discuss the advantages and disadvantages of each technique, as well as the complications and potential risks associated with their use. The choice of implant fixation strategy depends on several factors, including the location and severity of the fractures, the patient’s age and overall health, and the surgeon’s experience and preferences. By understanding the principles and best practices of implant fixation strategies, orthopaedic surgeons can optimize patient outcomes and improve the long-term prognosis for those with multiple fractures in a single bone. Overall, this chapter provides a comprehensive overview of the current state of implant fixation strategies for managing multiple fractures in a single bone, with a focus on evidence-based recommendations and practical considerations for the clinician.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 1,599.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 1,599.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Alho A. Concurrent ipsilateral fractures of the hip and femoral shaft: a meta-analysis of 659 cases. Acta Orthop. 1996;67(1):19–28. https://doi.org/10.3109/17453679608995603.

    Article  CAS  Google Scholar 

  2. Zettas JP, Zettas P. Ipsilateral fractures of the femoral neck and shaft. Clin Orthop Relat Res. 1981;160:63–73. http://www.ncbi.nlm.nih.gov/pubmed/7285439. Accessed 13 Apr 2020.

    Article  Google Scholar 

  3. Wolinsky PR, Johnson KD. Ipsilateral femoral neck and shaft fractures. In: Clinical orthopaedics and related research. New York: Springer; 1995. p. 81–90. https://doi.org/10.4055/jkoa.1991.26.5.1434.

    Chapter  Google Scholar 

  4. Alho A. Concurrent ipsilateral fractures of the hip and shaft of the femur. A systematic review of 722 cases. Ann Chir Gynaecol. 1997;86(4):326–36.

    CAS  PubMed  Google Scholar 

  5. Boulton CL, Pollak AN. Special topic: ipsilateral femoral neck and shaft fractures - does evidence give us the answer? Injury. 2015;46(3):478–83. https://doi.org/10.1016/j.injury.2014.11.021.

    Article  PubMed  Google Scholar 

  6. Peljovich AE. Ipsilateral femoral neck and shaft fractures. J Am Acad Orthop Surg. 1998;6(2):106–13. https://journals.lww.com/jaaos/Abstract/1998/03000/Ipsilateral_Femoral_Neck_and_Shaft_Fractures.5.aspx. Accessed 13 Apr 2020.

    Article  CAS  PubMed  Google Scholar 

  7. Parfenchuck TA, Carter LW, Young TR. Ipsilateral fractures of the femoral neck and shaft. Orthop Rev. 1993;22(3):356–63. http://www.ncbi.nlm.nih.gov/pubmed/8474773. Accessed 13 Apr 2020.

    CAS  PubMed  Google Scholar 

  8. O’Toole RV, Dancy L, Dietz AR, et al. Diagnosis of femoral neck fracture associated with femoral shaft fracture. J Orthop Trauma. 2013;27(6):325–30. https://doi.org/10.1097/BOT.0b013e318271b6c8.

    Article  Google Scholar 

  9. Hammer AJ. Nonunion of subcapital femoral neck fractures. J Orthop Trauma. 1992;6(1):73–7. http://www.ncbi.nlm.nih.gov/pubmed/1556627. Accessed 13 Apr 2020.

    CAS  PubMed  Google Scholar 

  10. Swiontkowski MF, Hansen ST, Kellam J. Ipsilateral fractures of the femoral neck and shaft. A treatment protocol. J Bone Jt Surg A. 1984;66(2):260–8. https://doi.org/10.2106/00004623-198466020-00013.

    Article  CAS  Google Scholar 

  11. Vidyadhara S, Rao SK. Cephalomedullary nails in the management of ipsilateral neck and shaft fractures of the femur-one or two femoral neck screws? Injury. 2009;40(3):296–303. https://doi.org/10.1016/j.injury.2008.08.009.

    Article  CAS  PubMed  Google Scholar 

  12. Casey MJ, Chapman MW. Ipsilateral concomitant fractures of the hip and femoral shaft. J Bone Jt Surg A. 1979;61(4):503–9. https://doi.org/10.2106/00004623-197961040-00003.

    Article  CAS  Google Scholar 

  13. Park YC, Um KS, Hong SP, Oh CW, Kim S, Yang KH. Preoperative “computed tomography capsular sign” for the detection of occult ipsilateral femoral neck fractures associated with femoral shaft fractures. Injury. 2020;51:1051–6. https://doi.org/10.1016/j.injury.2020.02.067.

    Article  PubMed  Google Scholar 

  14. Tornetta P, Kain MSH, Creevy WR. Diagnosis of femoral neck fractures in patients with a femoral shaft fracture. J Bone Jt Surg. 2007;89(1):39–43. https://doi.org/10.2106/JBJS.F.00297.

    Article  Google Scholar 

  15. Rogers NB, Hartline BE, Achor TS, et al. Improving the diagnosis of ipsilateral femoral neck and shaft fractures. J Bone Jt Surg. 2020;102(4):309–14. https://doi.org/10.2106/JBJS.19.00568.

    Article  Google Scholar 

  16. Chaturvedi S, Sahu SC. Ipsilateral concomitant fractures of the femoral neck and shaft. Injury. 1993;24(4):243–6. https://doi.org/10.1016/0020-1383(93)90178-9.

    Article  CAS  PubMed  Google Scholar 

  17. Bucholz RW, Rathjen K. Concomitant ipsilateral fractures of the hip and femur treated with interlocking nails. Orthopedics. 1985;8(11):1402–6. https://doi.org/10.3928/0147-7447-19851101-13.

    Article  CAS  PubMed  Google Scholar 

  18. Ostrum RF, Tornetta P, Watson JT, Christiano A, Vafek E. Ipsilateral proximal femur and shaft fractures treated with hip screws and a reamed retrograde intramedullary nail. In: Clinical orthopaedics and related research, vol. 472. New York: Springer; 2014. p. 2751–8. https://doi.org/10.1007/s11999-013-3271-5.

    Chapter  Google Scholar 

  19. Randelli P, Landi S, Fanton F, Hoover GK, Morandi M. Treatment of ipsilateral femoral neck and shaft fractures with the Russell-Taylor reconstructive nail. Orthopedics. 1999;22(7):673–6. https://doi.org/10.3928/0147-7447-19990701-06.

    Article  CAS  PubMed  Google Scholar 

  20. Singh R, Rohilla R, Magu NK, Siwach R, Kadian V, Sangwan SS. Ipsilateral femoral neck and shaft fractures: a retrospective analysis of two treatment methods. J Orthop Traumatol. 2008;9(3):141–7. https://doi.org/10.1007/s10195-008-0025-3.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Jain P, Maini L, Mishra P, Upadhyay A, Agarwal A. Cephalomedullary interlocked nail for ipsilateral hip and femoral shaft fractures. Injury. 2004;35(10):1031–8. https://doi.org/10.1016/j.injury.2003.09.039.

    Article  PubMed  Google Scholar 

  22. Gung Memorial Hospital C, Kao H-K, Wu C-C, et al. From the Department of Orthopaedic Surgery. Ipsilateral femoral neck and shaft fractures treated with Russell-Taylor reconstruction intramedullary nails. Chang Gung Med J. 2006;29:79–85.

    Google Scholar 

  23. Abalo A, Dossim A, Ouro Bangna AF, Tomta K, Assiobo A, Walla A. Dynamic hip screw and compression plate fixation of ipsilateral femoral neck and shaft fractures. J Orthop Surg (Hong Kong). 2008;16(1):35–8. https://doi.org/10.1177/230949900801600109.

    Article  CAS  PubMed  Google Scholar 

  24. Watson JT, Moed BR. Ipsilateral femoral neck and shaft fractures: Complications and their treatment. Clin Orthop Relat Res. 2002;399:78–86. https://doi.org/10.1097/00003086-200206000-00011.

    Article  Google Scholar 

  25. Sima W, Wiss D, Brien W. Ipsilateral femoral neck and shaft fractures. J Orthop Trauma. 1991;5(2):229–30. https://doi.org/10.1097/00005131-199105020-00056.

    Article  Google Scholar 

  26. Yang KH, Han DY, Park HW, et al. Fracture of the ipsilateral neck of THE femur in shaft nailing the role of CT in diagnosis. J Bone Joint Sugr Br. 1998;80:673.

    Article  CAS  Google Scholar 

  27. Khallaf F, Al-Mosalamy M, Al-Akkad M, Hantira H. Surgical treatment for ipsilateral fractures of femoral neck and shaft. Med Princ Pract. 2005;14:318–24. https://doi.org/10.1159/000086929.

    Article  CAS  PubMed  Google Scholar 

  28. Wiss DA, Sima W, Brien WW. Ipsilateral fractures of the femoral neck and shaft. J Orthop Trauma. 1992;6(2):159–66. https://doi.org/10.1097/00005131-199206000-00005.

    Article  CAS  PubMed  Google Scholar 

  29. Hoshino CM, Christian MW, O’Toole RV, Manson TT. Fixation of displaced femoral neck fractures in young adults: fixed-angle devices or Pauwel screws? Injury. 2016;47(8):1676–84. https://doi.org/10.1016/j.injury.2016.03.014.

    Article  CAS  PubMed  Google Scholar 

  30. Mohan K, Ellanti P, French H, Hogan N, McCarthy T. Single versus separate implant fixation for concomitant ipsilateral femoral neck and shaft fractures: a systematic review. Orthop Rev (Pavia). 2019;11(2):22–4. https://doi.org/10.4081/or.2019.7963.

    Article  Google Scholar 

  31. Bedi A, Karunakar MA, Caron T, Sanders RW, Haidukewych GJ. Accuracy of reduction of ipsilateral femoral neck and shaft fractures – an analysis of various internal fixation strategies. J Orthop Trauma. 2009;23(4):249–53. https://doi.org/10.1097/BOT.0b013e3181a03675.

    Article  PubMed  Google Scholar 

  32. Asnis SE, Wanek-Sgaglione L. Intracapsular fractures of the femoral neck. Results of cannulated screw fixation. J Bone Jt Surg. 1994;76(12):1793–803. https://doi.org/10.2106/00004623-199412000-00005.

    Article  CAS  Google Scholar 

  33. Tripathy SK, Goyal T, Sen RK. Management of femoral head osteonecrosis: current concepts. Indian J Orthop. 2015;49:28–45. https://doi.org/10.4103/0019-5413.143911.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Min BW, Kim SJ. Avascular necrosis of the femoral head after osteosynthesis of femoral neck fracture. Orthopedics. 2011;34(5):e6–e11. https://doi.org/10.3928/01477447-20110317-13.

    Article  Google Scholar 

  35. Page K, Barnett AG, Graves N. What is a hospital bed day worth? A contingent valuation study of hospital Chief Executive Officers. BMC Health Serv Res. 2017;17(1):137. https://doi.org/10.1186/s12913-017-2079-5.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Makridis KG, Tosounidis T, Giannoudis PV. Management of infection after intramedullary nailing of long bone fractures: treatment protocols and outcomes. Open Orthop J. 2013;7(1):219–26. https://doi.org/10.2174/1874325001307010219.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Duckworth AD, Phillips SA, Stone O, Moran M, Breusch SJ, Biant LC. Deep infection after hip fracture surgery: predictors of early mortality. Injury. 2012;43(7):1182–6. https://doi.org/10.1016/j.injury.2012.03.029.

    Article  PubMed  Google Scholar 

  38. Gillespie WJ, Walenkamp GH. Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures. Cochrane Database Syst Rev. 2010;3:CD000244. https://doi.org/10.1002/14651858.cd000244.pub2.

    Article  Google Scholar 

  39. Kubiak EN, Camuso MR, Barei DP, Nork SE. Operative treatment of ipsilateral noncontiguous unicondylar tibial plateau and shaft fractures: combining plates and nails. J Orthop Trauma. 2008;22(8):560–5. https://doi.org/10.1097/BOT.0b013e318185fa7e.

    Article  PubMed  Google Scholar 

  40. Keating JF, Kuo RS, Court-Brown CM. Bifocal fractures of the tibia and fibula. Incidence classification and treatment. J Bone Jt Surg B. 1994;76(3):395–400. https://doi.org/10.1302/0301-620x.76b3.8175840.

    Article  CAS  Google Scholar 

  41. Barei DP, OʼMara TJ, Taitsman LA, Dunbar RP, Nork SE. Frequency and fracture morphology of the posteromedial fragment in bicondylar tibial plateau fracture patterns. J Orthop Trauma. 2008;22(3):176–82. https://doi.org/10.1097/BOT.0b013e318169ef08.

    Article  PubMed  Google Scholar 

  42. Brown TD, Anderson DD, Nepola JV, Singerman RJ, Pedersen DR, Brand RA. Contact stress aberrations following imprecise reduction of simple tibial plateau fractures. J Orthop Res. 1988;6(6):851–62. https://doi.org/10.1002/jor.1100060609.

    Article  CAS  PubMed  Google Scholar 

  43. Honkonen SE. Indications for surgical treatment of tibial condyle fractures. Clin Orthop Relat Res. 1994;302:199–205. https://doi.org/10.1097/00003086-199405000-00031.

    Article  Google Scholar 

  44. Kettelkamp DB, Hillberry BM, Murrish DE, Heck DA. Degenerative arthritis of the knee secondary to fracture malunion. Clin Orthop Relat Res. 1988;234:159–69. https://doi.org/10.1097/00003086-198809000-00029.

    Article  Google Scholar 

  45. Stoffel K, Dieter U, Stachowiak G, Gächter A, Kuster MS. Biomechanical testing of the LCP – how can stability in locked internal fixators be controlled? Injury. 2003;34(Suppl 2):11–9. https://doi.org/10.1016/j.injury.2003.09.021.

    Article  Google Scholar 

  46. Holland TS, Prior CP, Walton RD. Distal tibial triplane fracture with ipsilateral tibial shaft fracture: a case series. Surgeon. 2018;16(6):333–8. https://doi.org/10.1016/j.surge.2018.03.004.

    Article  PubMed  Google Scholar 

  47. Jarvis JG, Miyanji F. The complex triplane fracture: ipsilateral tibial shaft and distal triplane fracture. J Trauma. 2001;51(4):714–6. https://doi.org/10.1097/00005373-200110000-00015.

    Article  CAS  PubMed  Google Scholar 

  48. De Rover WBS, Alazzawi S, Hallam PJ, Walton NP. Ipsilateral tibial shaft fracture and distal tibial triplane fracture with an intact fibula: a case report. J Orthop Surg. 2011;19(3):364–6. https://doi.org/10.1177/230949901101900321.

    Article  Google Scholar 

  49. Cooperman DR, Spiegel PGLG. Tibial fractures involving the ankle in children. The so-called triplane epiphyseal fracture. J Bone Jt Surg. 1978;60(8):1040–6.

    Article  CAS  Google Scholar 

  50. Spiegel PG, Cooperman DR, Laros GS. Epiphyseal fractures of the distal ends of the tibia and fibula. A retrospective study of two hundred and thirty-seven cases in children. J Bone Jt Surg. 1978;60(8):1046–50.

    Article  CAS  Google Scholar 

  51. Schurz M, Binder H, Platzer P, Schulz M, Hajdu S, Vécsei V. Physeal injuries of the distal tibia: long-term results in 376 patients. Int Orthop. 2010;34(4):547–52. https://doi.org/10.1007/s00264-009-0851-9.

    Article  PubMed  Google Scholar 

  52. Kling TF, Bright RW, Hensinger RN. Distal tibial physeal fractures in children that may require open reduction. J Bone Joint Surg Am. 1984;66(5):647–57. http://www.ncbi.nlm.nih.gov/pubmed/6725313. Accessed 17 Apr 2020.

    Article  PubMed  Google Scholar 

  53. Kontakis GM, et al. Dislocation of the shoulder and ipsilateral fracture of the humeral shaft: case reports and literature review. J Trauma Inj Infect Crit Care. 1995;39(5):990–2.

    Article  CAS  Google Scholar 

  54. Flint JH, Carlyle LM, Christiansen CC, Nepola JV. Case report and literature review anterior shoulder dislocation with three-part proximal humerus fracture and humeral shaft fracture. Iowa Orthop J. 2009;29:105–13.

    PubMed  PubMed Central  Google Scholar 

  55. Chun JM, Pawaskar A, Jeon IH. Fracture dislocation of the proximal humerus with ipsilateral shaft fracture: a report of two cases. Acta Orthop Traumatol Turc. 2013;47(5):370–5. https://doi.org/10.3944/AOTT.2013.2818.

    Article  PubMed  Google Scholar 

  56. Srinivas S, Kasis A. Co-existing fractures of the proximal humerus and humeral shaft without shoulder dislocation-a rare injury. Ann R Coll Surg Engl. 2010;92(2):1–4. https://doi.org/10.1308/147870810X476782.

    Article  Google Scholar 

  57. Neer CS. Displaced proximal humeral fractures. JBJS. 1970;52(6):1090–103.

    Article  Google Scholar 

  58. Barquet A, Schimchak M, Carreras O, Leon H, Masliah R. Dislocation of the shoulder with fracture of the ipsilateral shaft of the humerus. Injury. 1985;16(5):300–2. https://doi.org/10.1016/0020-1383(85)90128-7.

    Article  CAS  PubMed  Google Scholar 

  59. Sankaran-Kutty M, Sadat-Ali M. Dislocation of the shoulder with ipsilateral humeral shaft fracture. Arch Orthop Trauma Surg. 1989;108(1):60–2. https://doi.org/10.1007/BF00934162.

    Article  CAS  PubMed  Google Scholar 

  60. Sasashige Y, Kurata T, Masuda Y, Shimono K, Nagata Y. Dislocation of the shoulder joint with ipsilateral humeral shaft fracture: two case reports. Arch Orthop Trauma Surg. 2006;126(8):562–7. https://doi.org/10.1007/s00402-005-0090-5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany

    Kai Hoffeld

  2. Technical University of Munich, Munich, Germany

    Peter Biberthaler

  3. Department of Orthopaedics, Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, India

    Saseendar Shanmugasundaram

Authors
  1. Kai Hoffeld
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter Biberthaler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Saseendar Shanmugasundaram
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Saseendar Shanmugasundaram .

Editor information

Editors and Affiliations

  1. NH Narayana Superspeciality and Multispeciality Hospitals, Howrah, West Bengal, India

    Arindam Banerjee

  2. Technical University of Munich, Munich, Germany

    Peter Biberthaler

  3. Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, India

    Saseendar Shanmugasundaram

Section Editor information

  1. Professor and Department chair, Technical University of Munich, Munich, Germany

    Peter Biberthaler

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Springer Nature Singapore Pte Ltd.

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Hoffeld, K., Biberthaler, P., Shanmugasundaram, S. (2023). Orthopaedic Implant Fixation Strategies for Multiple Fractures in a Single Bone. In: Banerjee, A., Biberthaler, P., Shanmugasundaram, S. (eds) Handbook of Orthopaedic Trauma Implantology. Springer, Singapore. https://doi.org/10.1007/978-981-19-7540-0_40

Download citation

  • DOI: https://doi.org/10.1007/978-981-19-7540-0_40

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-19-7539-4

  • Online ISBN: 978-981-19-7540-0

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation