[Combined fractures of the femoral neck with femoral shaft fractures]

Abstract

Ipsilateral fractures of the femoral neck and shaft presents diagnostic difficulties and complex choices as to treatment. The surgeon is often faced with a multiply-injured patient with an obvious fracture of the femoral shaft. The accompanying femoral neck fracture can be overlooked (20-50%). Most frequently, the missed fracture is a minimally displaced vertical fracture of the femoral neck. Reviewing the literature on the subject offers little guidance of managing this fracture combination. Our present protocol for this double fracture is treatment with immediate internal fixation: 1. ISS < 25: Interlocking nailing for the shaft fracture and supplementary screws for the neck fracture, 2. ISS > 25: Plating for the shaft fracture and screwing for the neck fracture. The aseptic necrosis of the femoral head is not frequent.