Skip to main content

Advertisement

SpringerLink
Log in

A comparison of the incidence of concomitant ipsilateral femoral neck fractures in ballistic versus blunt femur fractures

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Objective

The purpose of this study is to evaluate the rate of ipsilateral femoral neck fractures in ballistic femur fractures and compare this to similar non-ballistic blunt fractures.

Design and setting

A retrospective review of an institutional trauma database was completed at a single Level 1 trauma academic medical center.

Patients

All patients treated for a ballistic or blunt femur fracture presenting to our institution between May 1, 2018, and February 29, 2020, were included. In all, 270 femur fractures were identified. We excluded 73, including 29 pediatric fractures and 44 geriatric peritrochanteric fractures. The final cohort included 197 femur fractures in 187 patients. Of the 197 femur fractures included, 68 were ballistic and 129 were blunt mechanism.

Results

Four ipsilateral femoral neck fractures were identified in the ballistic fracture cohort. There was no significant difference between ipsilateral femoral neck fractures associated with blunt femur fractures when compared with ballistic fractures, 7.7 versus 5.8%, respectively. We identified one occult femoral neck fracture that was associated with a ballistic 32-B3 femoral shaft fracture. The ipsilateral femoral neck fracture associated with the 32-B3 ballistic femoral shaft fracture was not identified on plain films (Fig. 3A, B) and review of CTA during initial trauma workup. Identification of this fracture intra-operatively changed the treatment plan from standard proximal locking to recon proximal locking for this case. Patients included in the blunt fracture cohort were more likely to be poly-trauma patients with a higher rate of associated fractures.

Conclusions

We detected no difference in rate of associated femoral neck fracture between blunt and ballistic femur fractures. These fractures can be missed on initial evaluation, which may lead to a delayed diagnosis and alter treatment plans. The authors conclude that treating surgeons must remain vigilant with a high index of suspicion for occult femoral neck fractures in patients who suffer ballistic femoral shaft fractures. Low-energy ballistic injuries should not rule out the possibility of an occult femoral neck fracture.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Alho A (1996) Concurrent ipsilateral fractures of the hip and femoral shaft: a meta-analysis of 659 cases. Acta Orthop Scand 67:19–28

    Article  CAS  PubMed  Google Scholar 

  2. Jones CB, Walker JB (2018) Diagnosis and management of ipsilateral femoral neck and shaft fractures. J Am Acad Orthop Surg 26:e448–e454

    Article  PubMed  Google Scholar 

  3. Tornetta P 3rd, Kain MS, Creevy WR (2007) Diagnosis of femoral neck fractures in patients with a femoral shaft fracture. Improvement with a standard protocol. J Bone Joint Surg Am 89:39–43

    Article  PubMed  Google Scholar 

  4. Ostrum RF, Tornetta P 3rd, 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 472:2751–2758

    Article  PubMed  Google Scholar 

  5. 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 23:254–260

    Article  PubMed  Google Scholar 

  6. Boulton CL, Pollak AN (2015) Special topic: Ipsilateral femoral neck and shaft fractures: Does evidence give us the answer? Injury 46:478–483

    Article  PubMed  Google Scholar 

  7. Hak DJ, Mauffrey C, Hake M, Hammerberg EM, Stahel PF (2015) Ipsilateral femoral neck and shaft fractures: current diagnostic and treatment strategies. Orthopedics 38:247–251

    Article  PubMed  Google Scholar 

  8. Ritchey SJ, Schonholtz GJ, Thompson MS (1958) The dashboard femoral fracture pathomechanics, treatment, and prevention. J Bone Joint Surg Am 40-A:1347–1358

    Article  CAS  PubMed  Google Scholar 

  9. 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 7:16

    Article  PubMed  PubMed Central  Google Scholar 

  10. Heiney JP, Leeson MC, Vrabec GA (2009) Delayed diagnosis of an ipsilateral femoral neck fracture with an associated femoral shaft fracture in light of a negative computed tomography scan. J Trauma 67:E129–E131

    PubMed  Google Scholar 

  11. Dougherty PJ, Sherman D, Dau N, Bir C (2011) Ballistic fractures: indirect fracture to bone. J Trauma 71:1381–1384

    PubMed  Google Scholar 

  12. Li M, Ma YY, Fu RX, Feng TS (1988) The characteristics of the pressure waves generated in the soft target by impact and its contribution to indirect bone fractures. J Trauma 28:S104–S109

    Article  CAS  PubMed  Google Scholar 

  13. Tikka S, Cederberg A, Rokkanen P (1982) Remote effects of pressure waves in missile trauma. The intra-abdominal pressure changes in anesthetized pigs wounded in one thigh. Acta Chir Scand Suppl 508:167–173

    CAS  PubMed  Google Scholar 

  14. Fackler ML, Malinowski JA (1985) The wound profile: a visual method for quantifying gunshot wound components. J Trauma 25:522–529

    Article  CAS  PubMed  Google Scholar 

  15. Kieser DC, Carr DJ, Leclair SC, Horsfall I, Theis JC, Swain MV et al (2013) Gunshot induced indirect femoral fracture: mechanism of injury and fracture morphology. J R Army Med Corps 159:294–299

    Article  PubMed  Google Scholar 

  16. Ryan JM, Cooper GJ, Haywood IR, Milner SM (1991) Field surgery on a future conventional battlefield: strategy and wound management. Ann R Coll Surg Engl 73:13–20

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Fackler ML (1988) Wound ballistics: a review common misconceptions. JAMA 259:2730–2736

    Article  CAS  PubMed  Google Scholar 

  18. Huelke DF, Harger JH, Buege LJ, Dingman HG (1968) An experimental study in bio-ballistics: femoral fractures produced by projectiles–II. Shaft impacts J Biomech 1:313–321

    Article  CAS  PubMed  Google Scholar 

  19. Portney DA, Reddy M, Baker HP, Dillman DB, Dirschl DR, Strelzow JA (2021) Ballistic supracondylar distal femur fractures have lower rates of intra-articular extension than blunt distal femur fractures. J Orthop Trauma 35:361–365

    Article  PubMed  Google Scholar 

  20. Seng VS, Masquelet AC (2013) Management of civilian ballistic fractures. Orthop Traumatol Surg Res 99:953–958

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, The University of Chicago, 5758 S. Maryland Avenue, Dept 4B, Chicago, IL, 60637, USA

    Hayden P. Baker, James Dahm, Kathryn Schultz, Daniel Portney, Daryl Dillman & Jason Strelzow

Authors
  1. Hayden P. Baker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James Dahm
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kathryn Schultz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel Portney
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daryl Dillman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jason Strelzow
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hayden P. Baker.

Ethics declarations

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethical approval

Our study protocol was approved by our institution’s institutional review board committee and meets the guidelines of our responsible governmental agency. IRB approval number: IRB20-0403. IRB approval date: 4/22/2020.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The study was performed at The University of Chicago.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Baker, H.P., Dahm, J., Schultz, K. et al. A comparison of the incidence of concomitant ipsilateral femoral neck fractures in ballistic versus blunt femur fractures. Eur J Orthop Surg Traumatol 33, 843–850 (2023). https://doi.org/10.1007/s00590-022-03219-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-022-03219-w

Keywords

Search

Navigation