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Multicenter Study
. 2024 Nov 1;38(11S):S48-S53.
doi: 10.1097/BOT.0000000000002886.

Ipsilateral Femoral Neck and Shaft Fractures: Complex Injuries With High Rates of Femoral Shaft Nonunion

Douglas R Haase  1 , Augustine M Saiz Jr  2 , Jonathan G Eastman  3 , Timothy S Achor  3 , Andrew M Choo  3 , John W Munz  3 , Stephen J Warner  1
Affiliations
Multicenter Study

Ipsilateral Femoral Neck and Shaft Fractures: Complex Injuries With High Rates of Femoral Shaft Nonunion

Douglas R Haase et al. J Orthop Trauma. .

Abstract

Objective: To investigate nonunion rates and risk factors in patients with ipsilateral femoral neck and shaft fractures.

Design: Retrospective review.

Setting: Two Level I trauma centers.

Patient selection criteria: Two hundred seven patients treated for ipsilateral femoral neck (AO/OTA 31-B) and shaft (AO/OTA 32A-C) fractures from 2013 to 2022. Patients with less than 6 months of follow-up were excluded.

Outcome measures and comparisons: The primary outcome of this study was femoral shaft nonunion. Risk factors for nonunion were evaluated, including smoking, open fracture, delay to full weight-bearing, blood transfusions, and AO/OTA classification.

Results: Two hundred twenty-seven patients were initially identified, but only 154 patients had sufficient follow-up and were included in final analysis. The mean age was 38.9 years (SD = 15.3), and injury severity score was 19.5 (9.7). One hundred ten patients (71%) were male and 69 (45%) required intensive care unit care. Thirty-eight patients (25%) experienced an open fracture, and 44 fractures (29%) were AO/OTA Type C. Thirty patients (20%) underwent initial external fixation, and 88 patients (57%) received a perioperative transfusion. Thirty-four patients (22%) developed a femoral shaft nonunion, and 5 (3%) experienced a surgical site infection. Nonunion was associated with perioperative blood transfusion, AO/OTA Type C fracture, postoperative non-weight-bearing, and delay to full weight-bearing ≥12 weeks. Multivariable regression identified perioperative blood transfusion ≥3 (risk ratio [RR] = 1.91; CI, 1.12-2.72; P = 0.02) and AO/OTA Type C fracture (RR = 2.45; CI, 1.50-3.34; P = 0.001) as independent risk factors.

Conclusions: Ipsilateral femoral neck and shaft fractures remain difficult injuries to treat. Much attention is given to diagnosis and treatment of the femoral neck component. These results suggest that successful treatment of the femoral shaft component presents its own challenges with high nonunion rates.

Level of evidence: Prognostic Level III.

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Conflict of interest statement

The authors report no conflict of interest specifically relevant to this study.

References

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