Ipsilateral femoral neck and shaft fractures: a retrospective analysis of intramedullary reconstruction nailing versus retrograde intramedullary nailing plus lag screw fixation

Abstract

Objective To compare the outcomes and indications between intramedullary reconstruction nailing and retrograde intramedullary nailing plus lag screw fixation in the treatment of ipsilateral femoral neck and shaft fractures.Methods From January 2001 to May 2010,21 patients with ipsilateral femoral neck and shaft fractures were treated in our division.Ten of them underwent intramedullary reconstruction nailing(Group Ⅰ)and 11 underwent retrograde intramedullary nailing plus cancellous lag screw fixation(Group Ⅱ).There were no significant differences between the 2 groups with respect to gender,age,associated injury,anatomical location and type of fracture(P ＞ 0.05).The patients were evaluated at 1,3,6,9,12 months after surgery,and then every year postoperatively.Fisher exact test and t-test were performed to compare their rates of union and complications.Results The average follow-up was 27.1months(range,from 12 to 48 months)for the 21 patients.An unpaired t-test showed no significant differences with respect to follow-up time,operation time,intraoperative blood loss,postoperative drainage,time for radiographic union,time for clinical union and Friedman-Wyman score between the 2 groups(P ＞ 0.05).The hospitalization cast was significantly higher for Group I than for Group Ⅱ(t =16.710,P =0.016).There were no significant differences in either the rate of femoral shaft union(9/10 vs.10/11)or the rate of femoral neck union(9/10 vs.11/11)(P ＞ 0.05).Four postoperative complications occurred in Group I and 7 in Group Ⅱ.Conclusions The treatment choice for ipsilateral femoral neck and shaft fractures should depend on specific cases.Intramedullary reconstruction nailing should not be preferred in subcapital fractures or irreducible femoral neck fractures,while retrograde intramedullary nailing plus cancellous lag screw fixation may be an excellent choice for subcapital neck fractures and for distal femoral shaft fractures associated with distal femoral supracondylar or proximal tibial fractures. Key words: Femoral fractures;  Femoral neck fractures;  Fracture fixation, internal