Ipsilateral hip and femoral shaft fractures. Diagnosis and treatment protocol

Purpose of study Ten cases of ipsilateral hip and femoral shaft fractures w ere reviewed. Material and methods All patients were treated operatively for both fractur es between 1988 and 1997 in Pitie Hospital. Five were treated with antegrad e reamed intramedullary nails and cancellous screw fixation of the femoral neck, and 5 by long Gamma nail. The shaft fractures were fixed prior to def initive neck stabilization. Results Ipsilateral hip and femoral shaft fractures accounts for 5,6 p. 100 of the whole femoral shaft fractures registered in the same period. All ca ses occurred in young adults and resulted from high-energy impaction injuri es. There were numerous associated injuries and all patients were polytraum a. The hip fracture was initially overlooked in 1 case without subsequent n onunion or avascular necrosis. At a mean follow-up examination of 22 months , two-thirds had a good result and one-third a fair or a poor result. Nonun ion of the femoral neck occurred in one patient as a result of initial disp lacement and subsequent malreduction, while all shaft fractures united. Discussion X-ray films of the hip should be done in all cases of femoral sh aft fracture in order to decrease the high incidence of missed femoral neck fractures in ipsilateral injuries of the femur. The results indicate that patients with ipsilateral fractures of the femoral neck and shaft can obtai n good results when rigid anatomic stabilization of the femoral neck is per formed. The femoral shaft fracture is given first priority and is reduced a nd immobilized with antegrade closed intramedullary nailing. The femoral ne ck fracture is then treated with cancellous screw fixation or compression s crew with long Gamma nail. Conclusion The authors recommend the use of a long Gamma nail to fix this d ual fracture whenever possible.