Advertisement

Clinical Orthopaedics and Related Research®

, Volume 472, Issue 9, pp 2751–2758 | Cite as

Ipsilateral Proximal Femur and Shaft Fractures Treated With Hip Screws and a Reamed Retrograde Intramedullary Nail

  • Robert F. Ostrum
  • Paul TornettaIII
  • J. Tracy Watson
  • Anthony Christiano
  • Emily Vafek
Symposium: Femur Fractures: Contemporary Treatment Approaches

Abstract

Background

Although not common, proximal femoral fractures associated with ipsilateral shaft fractures present a difficult management problem. A variety of surgical options have been employed with varying results.

Questions/purposes

We investigated the use of hip screws and a reamed retrograde intramedullary (IM) nail for the treatment of this combined fracture pattern in terms of postoperative alignment (malunion), nonunion, and complications.

Methods

Between May 2002 and October 2011, a total of 95 proximal femoral fractures with associated shaft fractures were treated at three participating Level 1 trauma centers; all were treated with hip screw fixation (cannulated screws or sliding hip screws) and retrograde reamed IM nails. The medical records of these patients were reviewed retrospectively for alignment, malunion, nonunion, and complications. Followup was available on 92 of 95 (97%) of the patients treated with hip screws and a retrograde nail. Forty were treated with a sliding hip screw, and 52 were treated with cannulated screws.

Results

There were five proximal malunions in this series (5%). The union rate was 98% (90 of 92) for the femoral neck fractures and 91.3% (84 of 92) for the femoral shaft fractures after the initial surgery. There were two nonunions of comminuted femoral neck fractures after cannulated screw fixation. There was no difference in femoral neck union or alignment when comparing cannulated screws to a sliding hip screw. Four open comminuted femoral shaft fractures went on to nonunion and required secondary surgery to obtain union, and one patient developed symptomatic avascular necrosis.

Conclusions

The treatment of ipsilateral proximal femoral neck and shaft fractures with hip screw fixation and a reamed retrograde nail demonstrated a high likelihood of union for the femoral neck fractures and a low risk of malunion. Comminution and initial displacement of the proximal femoral fracture may still lead to a small incidence of malunion or nonunion, and open comminuted femoral shaft fractures still may progress to nonunion despite appropriate surgical management.

Level of Evidence

Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Keywords

Femoral Neck Screw Fixation Femoral Neck Fracture Shaft Fracture Femoral Shaft Fracture 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Alho A. Concurrent ipsilateral fractures of the hip and shaft of the femur: a systematic review of 722 cases. Ann Chir Gynaecol. 1997;86:326–336.PubMedGoogle Scholar
  2. 2.
    Bali K, Gahlot N, Aggarwal S, Goni V. Cephalomedullary fixation for femoral neck/intertrochanteric and ipsilateral shaft fractures: surgical tips and pitfalls. Chin J Traumatol. 2013;16:40–45.PubMedGoogle Scholar
  3. 3.
    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;23:249–253.PubMedCrossRefGoogle Scholar
  4. 4.
    Bennett FS, Zinar DM, Kilgus DJ. Ipsilateral hip and femoral shaft fractures. Clin Orthop Relat Res. 1993;296:168–177.PubMedGoogle Scholar
  5. 5.
    Bhandari M. Ipsilateral femoral neck and shaft fractures. J Orthop Trauma. 2003;17;138–140.PubMedCrossRefGoogle Scholar
  6. 6.
    Bose WJ, Corces A, Anderson LD. A preliminary experience with the Russell-Taylor reconstruction nail for complex femoral fractures. J Trauma. 1992;32:71–76.PubMedCrossRefGoogle Scholar
  7. 7.
    Cannada LK, Viehe T, Cates CA, Norris RJ, Zura RD, Dedmond B, Obremskey W, Bosse MJ; Southeastern Fracture Consortium. A retrospective review of high-energy femoral neck-shaft fractures. J Orthop Trauma. 2009;23:254–260.PubMedCrossRefGoogle Scholar
  8. 8.
    Gary JL, Taksali S, Reinert CM, Starr AJ. Ipsilateral femoral shaft and neck fractures: are cephalomedullary nails appropriate? J Surg Orthop Adv. 2011;20:122–125.PubMedGoogle Scholar
  9. 9.
    Hossam ElShafie M, Adel Morsey H, Emad Eid Y. Ipsilateral fracture of the femoral neck and shaft, treatment by reconstruction interlocking nail. Arch Orthop Trauma Surg. 2001;121:71–74.Google Scholar
  10. 10.
    Jain P, Maini L, Mishra P, Upadhyay A, Agarwal A. Cephalomedullary interlocked nail for ipsilateral hip and femoral shaft fractures. Injury. 2004;35:1031–1038.PubMedCrossRefGoogle Scholar
  11. 11.
    Kang S, McAndrew MP, Johnson KD. The reconstruction locked nail for complex fractures of the proximal femur. J Orthop Trauma. 1995;9:453–463.PubMedCrossRefGoogle Scholar
  12. 12.
    Koldenhoven GA, Burke JS, Pierron R. Ipsilateral femoral neck and shaft fractures. South Med J. 1997;90:288–293.PubMedCrossRefGoogle Scholar
  13. 13.
    Oh CW, Oh JK, Park BC, Jeon IH, Kyung HS, Kim SY, Park IH, Sohn OJ, Min WK. Retrograde nailing with subsequent screw fixation for ipsilateral femoral shaft and neck fractures. Arch Orthop Trauma Surg. 2006;126:448–453.PubMedCrossRefGoogle Scholar
  14. 14.
    Ostrum R, Poka A. Ipsilateral femoral hip and shaft fractures: a management protocol. Am J Orthop. 1999;28(1 suppl):4–11.Google Scholar
  15. 15.
    Peljovich AE, Patterson BM. Ipsilateral femoral neck and shaft fractures. J Am Acad Orthop Surg. 1998;6:106–113.PubMedGoogle Scholar
  16. 16.
    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;22:673–676.PubMedGoogle Scholar
  17. 17.
    Watson JT, Moed BR. Ipsilateral femoral neck and shaft fractures: complications and their treatment. Clin Orthop Relat Res. 2002;399:78–86.PubMedCrossRefGoogle Scholar
  18. 18.
    Wiss DA, Sima W, Brien WW. Ipsilateral fractures of the femoral neck and shaft. J Orthop Trauma. 1992;6:159–166.PubMedCrossRefGoogle Scholar
  19. 19.
    Wolinsky PR, Johnson KD. Ipsilateral femoral neck and shaft fractures. Clin Orthop Relat Res. 1995;318:81–90.PubMedGoogle Scholar
  20. 20.
    Wu CC, Shih CH. Ipsilateral femoral neck and shaft fractures: retrospective study of 33 cases. Acta Orthop Scand. 1991;62:346–351.PubMedCrossRefGoogle Scholar
  21. 21.
    Wu LD, Wu QH, Yan SG, Pan ZJ. Treatment of ipsilateral hip and femoral shaft fractures with reconstructive intramedullary interlocking nail. Chin J Traumatol. 2004;7:7–12.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Robert F. Ostrum
    • 1
  • Paul TornettaIII
    • 2
  • J. Tracy Watson
    • 3
  • Anthony Christiano
    • 2
  • Emily Vafek
    • 4
  1. 1.Department of OrthopaedicsUniversity of North CarolinaChapel HillUSA
  2. 2.Department of Orthopaedic SurgeryBoston University Medical CenterBostonUSA
  3. 3.Department of Orthopaedic SurgerySt Louis University HospitalSt LouisUSA
  4. 4.Department of Orthopaedic SurgeryWake Forest University School of MedicineWinston SalemUSA

Personalised recommendations