Ipsilateral fracture neck and shaft of femur: A prospective analysis of two methods

Abstract

Background: Optimum management of ipsilateral fracture neck and shaft of femur is controversial and lacks general consensus. Both fractures should be treated with implants that optimize fracture healing while minimizing complications. Major issues are diagnosing occult fracture neck of femur combined with ipsilateral shaft fracture which may be part of polytrauma, surgical decision making, and work up to prioritize fixation and the selection of optimal implant. In this study, we report 18 cases of ipsilateral fracture neck and shaft treated with two methods, i.e., single implant which is a nail versus double implants for two fractures which can be cannulated hip screw, dynamic hip screw (DHS), and plate or distal femoral nail. Materials and Methods: A total of 18 patients were treated and divided into two groups. Group 1 included eight patients (six males, two females) who were operated with cancellous hip screws or DHS for fracture neck and compression plate fixation for fracture shaft of femur. Group II included ten patients (eight males and two females) who were operated with cephalomedullary nailing. Results: The mean age was 32 and 36 years in Group I and Group II, respectively. The mean delay in surgery was 5 and 6 days, respectively. Average union time for femoral neck fracture in Group I and Group II were 14.1 and 16.2 weeks, respectively, and for shaft fractures, these time were 20 and 22 weeks, respectively. There were 6 (75%) good, 2 (25%) fair functional results in Group I. There were 7 (70%) good, 2 (20%) fair, and 1 (10%) poor functional results in Group II. Conclusion: Both the treatment methods used in the study gives satisfactory functional results. In displaced fracture neck of femur, it is better to use double implants for both the fractures. Unlike isolated fracture neck of femur, union in fracture neck, and shaft is usually better. In most of the cases, fracture neck of femur was undisplaced and gave satisfactory results with cephalomedullary nails.