Surgical treatment for ipsilateral fractures of femoral neck and shaft / 中华骨科杂志

ABSTRACT

Objective To investigate the surgical treatment for ipsilateral fractures of femoral neck and shaft. Methods 26 cases of ipsilateral fractures of femoral neck and shaft treated from January 1996 to December 2002 were retrospectively reviewed. There were 22 males and 4 females, with an average of 28 years (range 17-50 years). The causes of fractures were traffic accident in 17 and fall in 9. The femoral neck fractures were diagnosed in emergency in 16 cases, and delayedly in 10 cases. The delayed time was 3-75 days, with an average of 13.1 days. All cases were divided into three types according to the site of femeral shaft fracture. Type Ⅰ the proximal 1/3 femoral shaft fracture combined with neck fracture, in 3 cases; Type Ⅱ the middle 1/3 femoral shaft combined with neck fracture, in 18 cases; Type Ⅲ the distal 1/3 femoral shaft fracture combined with neck fracture in 5 cases. All cases were undergone surgical reduction and internal fixation. The femoral shaft fractures were stabilized with dynamic compression plate (DCP) in 13, with antegrade intramedullary locking nail in 2 cases, with retrograde intramudullary locking nail in 5 cases. The femoral neck fractures of these 20 patients were stabilized with cannulated lag screw. The femoral neck and shaft were stabilized with dynamic hip screw system (DHS) in 2, with constructive nail in 4. Results All of the patients were followed up for 3 to 9 years, with an average of 4.4 years. The femoral shaft fractures obtained rigid union at the latest follow-up study in 25. The duration for bone union ranged from 16 to 32 weeks, with an average of 20 weeks. The femoral neck fractures were united at the latest follow-up study in 25. The duration for bone union ranged from 12 to 28 weeks, with an average of 16 weeks. The complications included infection in 1, hardware failure in 1, nonunion of femoral neck fracture in 1 and osteonecrosis of femoral head in 1. Conclusion The ipsilateral fracture of femoral neck and shaft is rare, and the neck fracture is easy to miss diagnosis. The surgical treatment for ipsilateral fractures of femoral neck and shaft depends on the position of femoral shaft, and the situation of femoral neck.