Ipsilateral Femoral Shaft Fractures Research Articles

Delayed recognition of an ipsilateral femoral neck and shaft fracture leading to preventable subsequent complications: a case report

BackgroundIpsilateral femoral shaft and neck fractures are rare injuries, affecting mostly young patients who sustained high-energy traumas. In 19–50% of cases, the femoral fracture is misdiagnosed or overlooked at the initial presentation, with reportedly increased risk of complications such as non-union and avascular necrosis. We present a case of an ipsilateral femoral neck and shaft fracture, which was missed at initial presentation despite radiographic and computed tomography (CT) scan evaluation.Case presentationA 56-year old female was admitted to our institution following a high-energy trauma (fall from 6 m). Initial radiographic and CT scan evaluation revealed a displaced femoral shaft fracture but no other femoral fractures were detected. Closed reduction and external fixation of the femoral shaft fracture was performed in the emergency setting. Follow-up radiologic evaluations revealed an ipsilateral laterally displaced femoral neck fracture. Despite cephalomedullary nail fixation of both fractures performed on the third day from the initial injury, the patient developed a non-union of the femoral neck fracture, which led to cut-out of the lag screw with associated varus failure of the femoral neck fracture requiring surgical revision and implant of a bipolar hemiarthroplasty at one year follow up. The postoperative course was uneventful and the patient had a full long-term recovery.ConclusionThis case report exemplifies the need to maintain the highest level of suspiciousness for the concomitant presence of an ipsilateral femoral neck fracture when treating polytraumatized patients who sustained a femoral shaft fracture as a consequence of a high-energy trauma. Furthermore, the pre-operative standardized radiological evaluation (plain x-ray and CT scan) might not always help in ruling out these fractures. It is therefore necessary to adopt additional standardized radiographic protocols not only in the pre-operative but also in the intra-operative and immediate post-operative settings.

Ipsilateral femoral neck and shaft fractures: An analysis of two treatment methods

Background: Ipsilateral femoral neck and shaft fractures are extraordinary wounds that present a surgical challenge. It happens in roughly 6% to 9% of all femoral shaft fractures. In spite of this moderately basic introduction, decision-making frequently is troublesome. The principle target of this article is to think about treatment techniques in ipsilateral femoral neck and shaft fractures. Materials and Methods: A sum of 24 patients with ipsilateral femoral neck and shaft decision-making fractures were treated with PFNA-long or different plate mixes. We isolated patients into two gatherings. Gathering I included 13 patients who experienced surgery with cancellous lag screws or dynamic hip screws (DHS) joined with compression plate fixation. Gathering II included 11 patients who experienced surgery with reconstruction-type intramedullary nailing. Result: The mean age was 31 and 34 years in Group I and Group II, respectively. The normal follow-up periods were 19.9 and 20.2 months for bunches I and II, separately. Normal union time for femoral neck crack in Group I and Group II were 13.7 and 15.1 weeks, individually, and for shaft breaks, these time were 19 and 21 weeks, separately. There were 8 (61%) great, 4 (30%) reasonable practical outcomes in Group I. There were 8 (72%) great, 2 (19%) reasonable, and 1 (10%) poor practical outcomes in Group II. One instance of embed disappointment and nonunion of the femoral shaft fracture happened in group I. Conclusion: Both treatment strategies accomplished acceptable useful results in patients with ipsilateral basicervical femoral neck and shaft fractures.

Clinical efficacy of lengthened proximal femoral nail antirotation versus Gamma nail in treatment of proximal femoral fractures combined with femoral shaft fractures

Objective To investigate the clinical efficacy of lengthened proximal femoral nail antirotation (PFNA) and Gamma nail treatment of proximal femoral fractures (including the intertrochanteric and inferior intertrochanteric area) combined with ipsilateral femoral shaft fractures. Methods A retrospective case control study was made on 68 cases of proximal femoral fractures combined with ipsilateral femoral shaft fractures received from January 2013 to October 2014. According to the operation mode, the patients were assigned to PFNA group (30 cases) and Gamma nail group (38 cases). Between-group differences were compared in aspects of surgical condition, treatment effect, Visual Analogue Scale (VAS), postoperative hip function (Harris score) and living ability (Barthel index). Postoperative complications were recorded as well. Results Duration of follow-up was 12-24 months [(20.8±1.9)months]. Incision length in PFNA group was (5.4±1.2)cm versus (7.3±1.7)cm in Gamma nail group (P 0.05). Conclusion In treatment of proximal femoral fractures combined with ipsilateral femoral shaft fractures, the lengthened PFNA fixation has advantages over Gamma nail in terms of minor trauma, rapid postoperative recovery and significant effect. Key words: Femoral fractures; Fracture fixation, internal; Proximal femoral nail antirotation

Ipsilateral Femoral Neck and Shaft Fractures

Ipsilateral Femoral Neck and Shaft Fractures

WITHDRAWN: Incidence and risk factors of knee injuries associated with ipsilateral femoral shaft fractures: a multicentre retrospective analysis of 429 femoral shaft injuries

WITHDRAWN: Incidence and risk factors of knee injuries associated with ipsilateral femoral shaft fractures: a multicentre retrospective analysis of 429 femoral shaft injuries

Analysis of the results of ipsilateral hip and shaft femur fractures treated with reconstruction-type intramedullary nail or various plate combinations

<p class="abstract"><strong>Background:</strong> Ipsilateral femoral shaft and hip fractures are commonly encountered following high energy trauma. Despite many treatment methods, controversy exists regarding the optimal management of these fractures. This study was planned to compare reconstruction-type intramedullary nailing and various plate combinations on the fracture healing and functional outcome in patients with these fractures.</p><p class="abstract"><strong>Methods:</strong> 25 patients with ipsilateral femoral shaft and hip fractures were operated by one of the two modalities - cancellous lag screws or dynamic hip screw for fracture hip and compression plate fixation for fracture shaft of the femur (Group I, 13 patients) and Reconstruction-type intramedullary nailing alone (Group II, 12 patients) - depending on surgeon's preference. The functional results of the patients were assessed with the system used by Friedman and Wyman. Radiological and functional assessment was done by an independent evaluator blinded to the surgical procedure.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean age was 33.6±4.03 in group I and 35.3±4.04 years in group II (p=0.70). The average follow up was 15 months. The average union time for femoral neck fracture was 15.75±0.89 and 16.48±1.40 (p=0.36) weeks and for fracture shaft was 19.27±1.18 and 20.06±1.16 (p=0.15) in group I and group II respectively. 10 patients (76.9%) in group I and 9 (75%) in group II showed good functional results. Two patients needed re-operation in group I and one patient in group II.</p><strong>Conclusions:</strong> Ipsilateral femoral shaft and hip fractures can be treated satisfactorily either with nailing alone or various plate combinations with similar outcome.

Reverse distal femoral locking compression plate a salvage option in nonunion of proximal femoral fractures.

Background:When primary fixation of proximal femoral fractures with implants fails, revision osteosynthesis may be challenging. Tracts of previous implants and remaining insufficient bone stock in the proximal femur pose unique problems for the treatment. Intramedullary implants like proximal femoral nail (PFN) or surface implants like Dynamic Condylar Screw (DCS) are few of the described implants for revision surgery. There is no evidence in the literature to choose one implant over the other. We used the reverse distal femur locking compression plate (LCP) of the contralateral side in such cases undergoing revision surgery. This implant has multiple options of fixation in proximal femur and its curvature along the length matches the anterior bow of the femur. We aimed to evaluate the efficacy of this implant in salvage situations.Materials and Methods:Twenty patients of failed primary proximal femoral fractures who underwent revision surgery with reverse distal femoral locking plate from February 2009 to November 2012 were included in this retrospective study. There were 18 subtrochanteric fractures and two ipsilateral femoral neck and shaft fractures, which exhibited delayed union or nonunion. The study included 14 males and six females. The mean patient age was 43.6 years (range 22–65 years) and mean followup period was 52.1 months (range 27–72 months). Delayed union was considered when clinical and radiological signs of union failed to progress at the end of four months from initial surgery.Results:All fractures exhibited union without any complications. Union was assessed clinically and radiologically. One case of ipsilateral femoral neck and shaft fracture required bone grafting at the second stage for delayed union of the femoral shaft fracture.Conclusions:Reverse distal femoral LCP of the contralateral side can be used as a salvage option for failed fixation of proximal femoral fractures exhibiting nonunion.

Progress in diagnosis and treatment of ipsilateral femoral neck and shaft fracture

Ipsilateral femoral neck and shaft fractures are rare injuries, which are often caused by high-energy trauma and combined with multiple injuries, such as thoracic and abdominal injury, head injuries, and fractures of other sites.Delayed or missed diagnosis of the ipsilateral femoral neck fracture often occurs.When patients with femoral shaft fractures caused by high-energy trauma are admitted into hospital, physical examination should be conducted carefully.In addition to femoral shaft fractures, radiographs of the ipsilater hip and knee joints should been taken, simultaneously taking into consideration the potential effect of anteversion angle on the demonstration of femoral neck fracture.Computed tomograph and magnetic resonance imaging are advised to perform if necessary to facilitate early and accurate diagnosis of ipsilateral femoral neck fracture.Comprehensive evaluation should be done based on age, physical condition, associated injuries as well as fracture site, classification and injury severity.Accordingly, proper and reasonable surgical plan is made.During the operation, anatomical reduction of the fractures, especially femoral neck fractures, should be achieved, and then fixed with appropriate internal implants.Besides, attention should also be paid to the treatment of associated injuries as well as the prevention and management of complications.

Hoffa fracture associated with ipsilateral femoral shaft fracture: clinical feature and treatment

Hoffa fracture associated with ipsilateral femoral shaft fracture is very rare. Three cases of this rare type of injury were retrospectively reviewed. The sites of femoral shaft fractures and Hoffa fractures were documented. All femoral shaft fractures were managed with internal fixation. The rate of misdiagnosis for the Hoffa fractures was documented. Functions of the affected knees were evaluated according to the modified Hospital for Special Surgery (HSS) scores at two years follow-up. Femoral fractures were either transverse or composite in all three cases. Ipsilateral Hoffa fractures occurred at medial condyle in two cases, and lateral condyle in one case. Only one Hoffa fracture was identified preoperatively. All the femoral shaft fractures healed uneventfully. In the patient whose Hoffa fracture was correctly diagnosed, the modified HSS score was 94. In another patient, whose Hoffa fracture was treated by a second operation, the modified HSS score was 93. And in the third case, who refused additional operation for the Hoffa fracture, the modified HSS score was only 70. Conclusively femoral shaft fracture can be associated with ipsilateral Hoffa fracture, especially in motorcycle accident. This type of injury is very rare and misdiagnosis is common.

Low-Energy Traumatic Obturator Hip Dislocation with Ipsilateral Femoral Shaft Fracture in a Patient with Omolateral Knee Arthroplasty.

Ipsilateral obturator hip dislocation and femoral shaft fracture are rare. We report such a case in an older woman after a low-energy injury. She had a knee prostheses in the same limb. The patient was treated by open manipulative reduction of the luxation without opening joint and open reduction and internal fixation of the femur with angular stability plate and screws. We could not find a similar case in the literature. An early diagnosis of the dislocation is crucial in order to obtain good results. Great awareness and radiologic examination are fundamental to achieve precocious diagnosis of both these rare combined injuries, as treatment in these cases is considered an emergency. The first step was an attempt to reduce the dislocation by closed means but it failed. Then we performed a short approach at the trochanteric region and used Lambotte forceps to manoeuvre the proximal femur without opening the joint achieving reduction. Thereafter the femoral shaft fracture underwent open reduction and internal fixation with an angular stable plate. After a 2-year follow-up the outcome was very good.

Challenges in managing ipsilateral femoral neck and shaft fracture at Mission Hospital

Rarity of ipsilateral femoral neck and shaft fracture qualifies it as a difficult fracture to diagnose as well as treat. No ideal treatment option has been defined, and no ideal implant has been assigned for the management of such fractures. Fixation of ipsilateral fractures of femoral neck and shaft are technically demanding. They are also associated with complications such as osteonecrosis of femoral head, delayed union, varus malunion, and nonunion. Treating such complicated fractures in a level V trauma center such as rural mission hospital with limited resources multiplies the difficulty of managing such fracture. This case report highlights the outcome and challenges in treating a patient with ipsilateral femoral neck and shaft fracture in a mission hospital in rural central India.

Avulsion of the Femoral Attachment of Anterior Cruciate Ligament Associated with Ipsilateral Femoral Shaft Fracture in Skeletally Mature Patient: A Case Report

Avulsion of the Femoral Attachment of Anterior Cruciate Ligament Associated with Ipsilateral Femoral Shaft Fracture in Skeletally Mature Patient: A Case Report

Cephalomedullary fixation for femoral neck/intertrochanteric and ipsilateral shaft fractures: surgical tips and pitfalls

ObjectiveSurgical management options for femoral shaft fracture and ipsilateral proximal femur fracture vary from single-implant to double-implant fixation. Cephalomedullary fixation in such fractures has relative advantages over other techniques especially because of less soft tissue dissection and immediate postoperative weight bearing with accelerated rehabilitation. However the surgery is technically demanding and there is a paucity of literature describing the surgical techniques for this fixation. The aim of the study was to describe the surgical technique of cephalomedullary fixation for femoral shaft fracture and ipsilateral proximal femur fracture MethodsSixteen cases (10 males and 6 females with a mean age of 41.8years) of ipsilateral proximal femur and shaft fractures were treated by single-stage cephalomedullary fixation at tertiary level trauma center in northern India. The fractures were classified according to AO classification. An intraoperative record of duration of surgery as well as technical challenges unique to each fracture pattern was kept for all the patients ResultsThe most common proximal femoral pattern was AO B2.1 observed in 9 of our patients. The AO B2.3 fractures were seen in 4 patients while the AO A1.2 fractures in 3 patients. Four of the AO B2.1 and 2 of the AO B2.3 fractures required open reduction with Watson-Jones approach. The mean operative time was around 78minutes, which tended to decrease as the surgical experience increased. There was only one case of malreduction, which required revision surgery. ConclusionCombination of ipsilateral femoral shaft fracture and neck/intertrochanteric fracture is a difficult fracture pattern for trauma surgeons. Cephalomedullary nail is an excellent implant for such fractures but it requires careful insertion to avoid complications. Surgery is technically demanding with a definite learning curve. Nevertheless, a majority of these fractures can be surgically managed by singleimplant cephalomedullary fixation by following basic surgical principles that have been summarized in this article.

Ipsilateral femoral neck and shaft fractures: current diagnostic and treatment strategies.

Associated ipsilateral femoral neck fractures have been reported to occur in 1% to 9% of femoral shaft fractures. The associated femoral neck fracture is often nondisplaced, and the diagnosis is delayed or missed in up to one-third of cases. It is essential to carefully evaluate the femoral neck in all patients sustaining high-energy femoral shaft fractures. Although there are a number of different implant options available for management of this challenging injury, most authors recommend that priority be given to anatomic reduction and optimal stabilization of the femoral neck fracture because nonunion, malunion, or avascular necrosis of this injury is more difficult to successfully treat.

Treatment of Ipsilateral Basicervical Femoral Neck and Shaft Fractures with Cephalomedullary Nail (PFNA-II): Report of Two Cases and Review of Literature

Ipsilateral femoral neck and shaft fractures are rare types of fractures. Most surgeons have recommended fixation with two separate prostheses because the use of a single cephallomedullary device often results in higher rates of complication and malunion. Proximal femoral nail antirotation was designed initially for the fixation of peritrochanteric fractures while the second generation nail was introduced specifically to accommodate the femoral size and geometry of Asians. The application of the less-invasive, firstgeneration antirotation nail in the fixation of ipsilateral femoral neck and shaft fractures among Asians has resulted in similar outcome compared to the use of two separate prostheses; however, studies of the second-generation antirotation nail in the fixation of the aforementioned fractures have been insufficient. We present two patients with ipsilateral femoral neck and shaft fractures treated with the second-generation antirotation nail. After months of follow up, radiographs revealed proper alignment and complete union of the fractures. The patients were ambulatory with nearly full ranges of motion. We therefore conclude that reduction and fixation with the second-generation antirotation nail results in good functional result and satisfactory outcome.

Ipsilateral Acetabular and Femoral Neck and Shaft Fractures.

Floating hip injuries and ipsilateral femoral neck and shaft fractures are rare. Additionally, the simultaneous occurrence of these injuries is extremely rare, and only one case report of the simultaneous occurrence of these injuries has been published. Here, we report the case of a patient with ipsilateral acetabular and femoral neck and shaft fractures following a suicide attempt. The patient experienced nonunion of the femoral neck and shaft after the initial operation and therefore underwent reconstruction using a femoral head prosthesis with a long stem and interlocking screws. Our procedure may be used in primary and/or secondary reconstruction for ipsilateral acetabular and femoral neck and shaft fractures.

Treatment for Concurrent Ipsilateral Femoral Neck and Shaft Fractures Using Reconstruction Nail with Temporary K-Wires

23 Copyright c 2015 The Korean Fracture Society. All rights reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Received October 8, 2014 Revised October 22, 2014 Accepted November 21, 2014 Address reprint requests to: Sang Hong Lee, M.D. Department of Orthopedic Surgery, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 501-717, Korea Tel: 82-62-220-3147ᆞFax: 82-62-226-3379 E-mail: shalee@chosun.ac.kr

Special topic: Ipsilateral femoral neck and shaft fractures – Does evidence give us the answer?

Ipsilateral fractures of the femoral neck and shaft are rare, high-energy injuries that typically occur in young polytrauma patients. The associated fracture of the neck is often vertical in nature and is more frequently non-displaced than in isolated femoral neck fractures. Historically the diagnosis of an associated femoral neck fracture was delayed or missed in approximately one third of cases. Studies have shown that detection can be significantly improved with the implementation of a protocolized approach to hip imaging in all patients with femoral shaft fractures.Prompt recognition of an associated femoral neck fracture allows for timely stabilization and may decrease the risks of non-union and avascular necrosis. In contrast, failure to recognize a non-displaced or minimally displaced associated neck fracture prior to fixation of the shaft can lead to displacement, a decrease in neck fixation options, a technically challenging secondary procedure and increased risk of long-term sequelae.A vast array of treatment strategies have been described for this combined injury. Published options range from spica casting to open reduction and internal fixation of both fractures and include almost all conceivable combinations in between. While timely surgical stabilization is now universally recommended for both shaft and neck, no consensus exists as to the most appropriate method of fixation for either fracture. Most authors recommend prompt, but not emergent, surgery with priority given to anatomic reduction and stabilization of the neck fracture by either closed or open methods. Fixation of the shaft fracture follows as patient condition allows.The rare nature of this injury makes it very challenging to study and most published series’ are retrospective with very small sample sizes. In short, no scientificallycompelling study is available to definitively support any one implant choice or method of stabilzation over another for the treatment of associated fractures of the femoral neck and shaft.

Posterior Cruciate Ligament Reconstruction Using Single-Bundle Achilles Allograft with Open Tibial Inlay Fixation

Objectives:PCL reconstruction research has shown that the tibial inlay and transtibial tunnel procedures offer similar biomechanical results. The purpose of this study was to evaluate the early results of PCL reconstruction using a single-bundle Achilles allograft and tibial inlay fixation.Methods:We retrospectively studied 14 patients who had undergone PCL reconstruction using the direct tibial inlay fixation technique from 2009 to 2013, with a mean follow-up of 13.4 months. (6-28 months). The patients were 11males and 3 females with an average age of 29.2 years (17-41 years). Ipsilateral femoral shaft fractures were determined in 2 cases, ipsilateral trochanteric fracture in 1 case and popliteal artery injury in 1 case. Surgery was performed within 2-4 weeks. Spanning-joint external fixation was applied to 2 patients because of gross instability with failure to maintain reduction in a brace. Combined reconstructions involving the posterolateral corner (9/14), anterior cruciate ligament (ACL (11/14)), or medial collateral ligament (MCL (1/14)) were performed. All PCL reconstructions were performed with Achilles allograft. In 1 case with arterial injury, the repair was made by a cardiovascular surgeon. In 2 case, deep infection developed, which was controlled with debridement and antibiotic treatment. Superficial peroneal nerve injury in 1 case was treated with tenolysis in the 6th month, then partial healing was seen at 18 months. In all patients, the preoperative posterior drawer (PD) examination was positive. All patients were evaluated with preoperative and postoperative examination and x-rays. The International Knee Documentation Committee (IKDC) evaluation was applied to all patients at the final follow-up.Results:Postoperative PD examination demonstrated the following: 0 (normal) in 4 patients, 1+ in 7 patients, and 2+ in 3 patients, compared to the preoperative PD of 3+ or greater in all patients. Preoperative IKDC objective evaluation rated all knees as severely abnormal based on instability. The final follow-up objective IKDC evaluation distribution was as follows: A, 4 knees; B, 6 knees; C, 3 knees and D, 1 knee, compared to D in all 14 knees preoperatively. The average final follow-up IKDC subjective score was 74.1 (20-100).Conclusion:Despite transtibial PCL reconstruction being advocated by several authors, it has technical difficulties of the arthroscopic approach to the posterior compartment of the knee. In the open inlay technique, posterior arthrotomy allows accurate placement of the tibial PCL insertion, avoiding the killer curve and more closely duplicating the normal PCL anatomy. Based on our initial experience with this technique at early follow-up, we continue to use the tibial inlay technique as our preferred technique for isolated or combined reconstruction of the PCL.

Complications following young femoral neck fractures

BackgroundFemoral neck fractures in patients 60 years of age or younger are challenging injuries to treat because of the high-energy trauma mechanisms and the displaced fracture patterns typically found in this patient population. Understanding the burden of disease is an important first step in addressing treatment controversies in this population. The purpose of the current study is to quantitatively pool the incidence of patient important complications following internal fixation of young femoral neck fractures. MethodsA comprehensive search of the Medline, Embase, CINAHL, Cochrane Database of Systematic Reviews, and Central databases was completed under the direction of a biomedical librarian. Multiple outcomes of interest (complications) were collected and included: reoperation, femoral head avascular necrosis, fracture non-union, infection, implant failure, and malunion. Results1558 fractures from 41 studies were included in the meta-analysis. An18.0% pooled reoperation incidence was observed for isolated femoral neck fractures. The total pooled incidence of avascular necrosis (AVN) was 14.3%, and the total incidence of nonunion was 9.3%. When stratified for fracture displacement displaced fractures were more likely to undergo reoperation and to result in AVN or non-union. The total incidence of malunion was 7.1%, implant failure was 9.7%, and surgical site infection was 5.1%. Complications associated with a femoral neck fracture treated in conjunction with an ipsilateral femoral shaft fracture were lower overall than the pooled estimates for isolated neck fractures. ConclusionsThe results of our analysis demonstrate that the incidence of complications experienced by young femoral neck fracture patients is relatively high. Reoperation following internal fixation of isolated femoral neck fractures occurred in nearly 20% of cases, and AVN and nonunion were the most common complications that likely contributed to repeat surgeries. These results highlight the importance of further efforts to improve the clinical outcomes in this population.