Abstract
Introduction
Uncommon but increasingly diagnosed, ipsilateral femoral neck and shaft fracture represents a complex injury pattern with challenging management. The conundrum involves optimal diagnostic modality, timing of surgery, sequence of fixation, and the choice of implant.
Methodology
A retrospective review was conducted at a Level-I trauma centre to assess the outcome of concomitant femoral neck and shaft fractures managed with various implants and attempt to provide solutions to the aforementioned queries. The time between injury and definitive surgery, choice of implant, sequence of fixation, time to fracture union, and complications were documented and analyzed.
Results
A total of 46 patients were included in the study wherein associated neck fracture was identified preoperatively in 93.5% of patients. In patients with isolated limb fractures, the mean time to surgery was 16.7 ± 5 h whereas patients with polytrauma witnessed an average delay of 4.6 days before fracture fixation. 72% of patients were managed by dual implants and in the remaining both the fractures were addressed using a single implant with no union time difference amongst implants. The mean time to the union for neck fracture was 21.7 weeks and 24.2 weeks for shaft femur fracture. 21.7% patients developed delayed union of fracture shaft femur and infection complicated 11% shaft fractures.
Conclusion
Although, 6% neck fractures were missed in the series, we advocate that careful pre/intra/post-operative fluoroscopic evaluation of the femoral neck along with a low threshold for a pre-operative CT scan remains the optimal diagnostic modality while avoiding universal employment of computed tomography (CT). With fracture union being unaffected by implant choice, authors suggest that anatomical fixation of the femoral neck is of paramount importance followed by restoration of the length, alignment and rotation of the femoral shaft, and the implant selection primarily depends on surgeon’s experience and the pattern of injury.
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References
Delaney WM, Street DM (1953) Fracture of femoral shaft with fracture of neck of same femur; treatment with medullary nail for shaft and Knowles pins for neck. J Int Coll Surg 19(3):303–312
Peljovich AE, Patterson BM (1998) Ipsilateral femoral neck and shaft fractures. J Am Acad Orthop Surg 6(2):106–113
Tornetta P III, Kain MSH, Creevy WR (2007) Diagnosis of femoral neck fractures in patients with a femoral shaft fracture: improvement with a standard protocol. JBJS 89(1):39–43
Cannada LK, Viehe T, Cates CA, Norris RJ, Zura RD, Dedmond B et al (2009) A retrospective review of high-energy femoral neck-shaft fractures. J Orthop Trauma 23(4):254–260
Hak DJ, Mauffrey C, Hake M, Hammerberg EM, Stahel PF (2015) Ipsilateral femoral neck and shaft fractures: current diagnostic and treatment strategies. Orthopedics 38(4):247–251
Ostrum RF, Tornetta P, Watson JT, Christiano A, Vafek E (2014) Ipsilateral proximal femur and shaft fractures treated with hip screws and a reamed retrograde intramedullary nail. Clin Orthop Relat Res 472(9):2751–2758
Bennett FS, Zinar DM, Kilgus DJ (1993) Ipsilateral hip and femoral shaft fractures. Clin Orthop 296:168–177
Jones CB, Walker JB (2018) Diagnosis and management of ipsilateral femoral neck and shaft fractures. JAAOS-J Am Acad Orthop Surg 26(21):e448–e454
McDonald LS, Tepolt F, Leonardelli D, Hammerberg EM, Stahel PF (2013) A cascade of preventable complications following a missed femoral neck fracture after antegrade femoral nailing. Patient Saf Surg 7(1):16
Yang KH, Han DY, Park HW, Kang HJ, Park JH (1998) Fracture of the ipsilateral neck of the femur in shaft nailing: the role of CT in diagnosis. J Bone Joint Surg Br 80(4):673–678
O’Toole RV, Dancy L, Dietz AR, Pollak AN, Johnson AJ, Osgood G et al (2013) Diagnosis of femoral neck fracture associated with femoral shaft fracture: blinded comparison of computed tomography and plain radiography. J Orthop Trauma 27(6):325–330
Park YC, Um KS, Hong SP, Oh CW, Kim S, Yang KH (2020) Preoperative “Computed tomography capsular sign” for the detection of occult ipsilateral femoral neck fractures associated with femoral shaft fractures. Injury. 51(4):1051–1056. https://doi.org/10.1016/j.injury.2020.02.067
Rogers NB, Hartline BE, Achor TS, Kumaravel M, Gary JL, Choo AM et al (2020) Improving the diagnosis of ipsilateral femoral neck and shaft fractures: a new imaging protocol. JBJS 102(4):309–314
Bedi A, Karunakar MA, Caron T, Sanders RW, Haidukewych GJ (2009) Accuracy of reduction of ipsilateral femoral neck and shaft fractures-an analysis of various internal fixation strategies. J Orthop Trauma 23(4):249–253
Oh C-W, Oh J-K, Park B-C, Jeon I-H, Kyung H-S, Kim S-Y et al (2006) Retrograde nailing with subsequent screw fixation for ipsilateral femoral shaft and neck fractures. Arch Orthop Trauma Surg 126(7):448–453
Gary JL, Taksali S, Reinert CM, Starr AJ (2011) Ipsilateral femoral shaft and neck fractures: are cephalomedullary nails appropriate? J Surg Orthop Adv 20(2):122–125
Singh R, Rohilla R, Magu NK, Siwach R, Kadian V, Sangwan SS (2008) Ipsilateral femoral neck and shaft fractures: a retrospective analysis of two treatment methods. J Orthop Traumatol 9(3):141–147
Salama FH, Abdel-Kader MH, Mohamed OA (2014) Ipsilateral femoral neck and shaft fractures: treatment with a reconstructive interlocking nail. Egypt Orthop J 49(3):183
Wu K-T, Lin S-J, Chou Y-C, Cheng H-H, Wen P-C, Lin C-H et al (2020) Ipsilateral femoral neck and shaft fractures fixation with proximal femoral nail antirotation II (PFNA II): technical note and cases series. J Orthop Surg 15(1):1–7
Watson JT, Moed BR (2002) Ipsilateral femoral neck and shaft fractures: complications and their treatment. Clin Orthop Relat Res 399:78–86
Randelli P, Landi S, Fanton F, Hoover GK, Morandi M (1999) Treatment of ipsilateral femoral neck and shaft fractures with the Russell-Taylor reconstructive nail. Orthopedics 22(7):673–676
Denisiuk M, Afsari A (2021) Femoral shaft fractures. Jan 9. In: StatPearls [Internet]. StatPearls Publishing, Treasure Island. PMID: 32310517
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Gupta, A., Jain, A., Mittal, S. et al. Ipsilateral femoral neck and shaft fractures: case series from a single Level-I trauma centre and review of literature. Eur J Orthop Surg Traumatol 33, 803–809 (2023). https://doi.org/10.1007/s00590-021-03199-3
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DOI: https://doi.org/10.1007/s00590-021-03199-3