Ipsilateral fractures of the femoral neck, shaft and distal end: long-term outcome of five cases

Abstract

Out of 52 cases of ipsilateral femoral fractures treated at a level I trauma centre between June 1994 and March 2008, the diaphyseal fracture was accompanied by a intracapsular neck fracture in only 20 cases. In the rest of the cases, the diaphyseal fracture was combined with either an extracapsular or pertrochanteric fracture. Five of these patients also had fractures of the distal femur. In three of those patients we began treatment with osteosynthesis of the femoral neck and shaft, using a reconstruction nail, then stabilized the distal fracture with a 95° blade plate or with lag screws. In the other two cases, initial treatment dealt with the distal femoral fracture, stabilizing it with a 95° blade plate, which was also used for stabilization of the diaphyseal fracture. In these patients, the proximal fracture was treated using dynamic hip screws (DHS). All fractures healed, two after initial treatment, while the other three needed one reoperation. The follow-up period was 2-13 years after the injury. The order in which fractures are treated is best left to the discretion of the physician and the circumstances. In our experience, two implants are sufficient for osteosynthesis, one for stabilizing one end of the femur together with the shaft, and the other is used for treating the other end of the femur.

Fig. 1

A motorbike driver (male, 26 years old) was hit by a car. a A vertical basicervical fracture of the left femur (31-B2), together with a transverse middle-third shaft fracture with an interfragment (32-B2). b Anteroposterior view. c Lateral view of open dislocated fracture of lateral condyle (33-B2) combined with impact medial condyle fracture and an open transverse dislocated fracture of left patella

Fig. 2

Postoperative X-ray of patient from Fig. 1. a The neck and shaft fractures of the left femur were treated using a long PFH Medin. The lateral condylar fracture was reduced and fixated using four lag screws. The patellar fracture was treated using a cerclage. b The fractures of femoral neck, distal femur and patella healed within five months. The patellar cerclage was removed six months after the injury. c The diaphyseal femoral fracture was still not healed 12 months after the accident. Moreover, the distal locking screws of the nail were broken. d Because of non-union of the femoral shaft, re-nailing was performed using a reamed femoral nail with dynamic locking

Fig. 3

A 40-year-old man was involved in a motor vehicle accident as a driver. He suffered fractures of both femurs. a The right femur had a vertical fracture of the neck (31-B2), an oblique middle-third shaft fracture with an interfragment (32-B2), and a T-shaped fracture of the distal femur (33-C1). The left femur had a stable pertrochanteric fracture (31-A1) and a fragmented wedge fracture of the shaft (32-B3). b Ipsilateral fractures of left femur were treated using a long Gamma-nail. The fracture of right neck was treated using a Dynamic Hip Screw (DHS Synthes). The fixation of diaphysis and distal part of right femur was performed using a 95° blade plate. c The left femur healed without complications six months after the trauma. The fracture of the neck of the right femur healed in three months and that of the distal femur healed in six months. A delayed union occurred in shaft fracture, a decortication with cancellous bone grafting was therefore performed six months after the injury