Fixation System Design in Ipsilateral Proximal Femur and Diaphyseal Fractures in Elderly Patients

Abstract

Ipsilateral proximal femur combined with diaphyseal fracture is a rare and problematic combination of injuries with serious potential complications first reported in the literature by Delaney and Street in 1953. This paper offers a retrospective view of 21 cases involving ipsilateral, proximal and diaphyseal fractures in elderly patients who were treated in our department, in order to emphasize the challenges of managing these pathological entities in elderly patients and the need for improvement of implant design. A number of 21 patients treated in our department, over a five year period for ipsilateral, combined proximal (intertrochanteric or femoral neck fractures) and femoral shaft fractures was selected. The cases were the result of various types of trauma as follows: 8 patients injured in motor vehicle accidents, 11 falls from standing position and 2 falls from more than own height. No open fractures or pathological fractures were recorded for this study. The patients were grouped according to treatment approach as group A (n=13), managed using intramedullary fixation devices and group B (n=8), treated with plating. All 21 patients were followed-up for 1 to 2 years after surgery. The data was analysed using Student's t-test and a comparison between the two groups was devised. None of the available fixation methods has shown clear superiority for addressing this fracture association. The multitude of variables affecting the management of this injury pattern is complemented by the poor local biomechanical environment provided by the low bone mineral density characteristic for the elderly patients. This raises the challenge of improving the design of the implants to better suit the biomechanical requirements, which sometimes are dictated by the age of the patients.