Application of bridge-link type combined fixation system in the treatment of trifocal femoral fractures.

Abstract

Ipsilateral combined fractures of the proximal femur, femoral shaft, and distal femur, though uncommon, present significant treatment challenges for orthopaedic surgeons. This retrospective study aims to investigate the intraoperative and long-term postoperative outcomes of this combination fracture when treated using a bridge-link type combined fixation system (BCFS). Four individuals received treatment at a level 1 trauma centre between January 2013 and December 2017 for combined fractures of the proximal femur, femoral shaft, and distal femur. The medical records of these patients were retrospectively examined. In addition to minimally invasive percutaneous plate osteosynthesis (MIO), all patients underwent BCFS. The median follow-up period for each patient was 28.5 months. The median duration of the surgical procedure was 176.0 min, with intraoperative haemorrhage measured at 470.0 ml. Among the cases, three patients showed firm union of the femoral shaft fractures. However, one patient experienced nonunion 12 months after the procedure, while another patient suffered from refracture of the femoral shaft and postoperative avascular necrosis of the femoral head. At the time of the last follow-up, the Friedman-Wyman functional scores were excellent in one case, good in two cases, and fair in one case. Trifocal femoral fractures lack a widely approved therapeutic strategy. Nonetheless, BCFS may present itself as a viable alternative for treating this type of fracture, offering positive clinical outcomes.