Diagnosis and treatment of ipsilateral fractures of femoral neck and shaft: a discussion based on an internet database

Abstract

Objective To discuss diagnosis and treatment of ipsilateral fractures of femoral neck and shaft based on an internet orthopaedic trauma database.MethodsWe searched Ihrough htpp://www.orthochina.ors for papers on diagnosis and treatment of fractures of femoral shaft which were published from 1st November,2005 to 31st December,2008.We collected 128 cases of femoral shaft fractures.including 18 cager of ipsilateral fractures of femoral neck and shaft,Their diagnoses and treatments were analyzed in terms of geographic distribution of hospital,ranking of hospital,treatment protocols and intemal fixations. Results 14.1%(18/128)of the femoral shaft fractures were simultaneously coupled with ipsilateral femoral neck fracture.38.9%(7/18)of the ipsilateral fractures of femoral neck and shaft had been overlooked.Of the 7 neglected cases,only one was found intra-operatively and repaired,6(85.7%)remained untreated after fixation for the femoral shaft fracture.The neglects were committed by surgeons-in-charge from Grade 2 hospitals.Eleven cases whose ipsilateral fractures of femoral neck and shaft had been diagnosed early enjoyed good longterm results after plate fixation for the shaft fracture and cannulated lag screws for the neck fracture or proximal femoral nailing(PFN)for both neck and shaft fractures.Of the 6 neglected cases,3 received fixation with cannulated lag screws in revision but could not walk independently 9 months after surgery,and 3 suffered from femoral head necrosis after conservative treatment without further internal fixation.Conclusions The internet database highlights a petential risk of neglcoting ipsilateral fractures of femoral neck and shaft and poor consequences of revision. Measures must be taken to prevent misdiagnosis and overlook of the femoral neck fracture complicated with the femoral shaft fracture. Key words: Femoral fractures; Fenoral neck fractures; Data collection; Diagnosis; Thcrapy