Sang-Joon Lee; Sang Hong Lee; Sang Ho Ha; Gwang-Chul Lee

doi:10.12671/jkfs.2015.28.1.23

Articles

Page Path: HOME > J Musculoskelet Trauma > Volume 28(1); 2015 > Article

Original Article
Treatment for Concurrent Ipsilateral Femoral Neck and Shaft Fractures Using Reconstruction Nail with Temporary K-Wires: Sang-Joon Lee, M.D., Sang Hong Lee, M.D., Sang Ho Ha, M.D., Gwang-Chul Lee, M.D.; Journal of the Korean Fracture Society 2015;28(1):23-29.
DOI: https://doi.org/10.12671/jkfs.2015.28.1.23
Published online: January 20, 2015

Department of Orthopedic Surgery, Chosun University School of Medicine, Gwangju, Korea.

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: 82-62-220-3147, Fax: 82-62-226-3379, shalee@chosun.ac.kr

• Received: October 8, 2014 • Revised: October 22, 2014 • Accepted: November 21, 2014

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.

104 Views
0 Download

prev next

Full Article

Download PDF

Abstract
NOTES
REFERENCES

Abstract

Purpose
The purpose of this study is to evaluate the results of operative treatment using a reconstruction nail after temporary K-wire fixation of the femoral neck for ipsilateral femoral neck and shaft fractures.
Materials and Methods
A total of 11 cases were treated, which were followed-up for more than two years, between August 2007 and July 2012. The average age was 51 years (29-69 years) and men were dominant counting eight cases. All cases were operated with a reconstruction nail after temporary K-wire fixation of the femoral neck. Bone union periods, alignment, etc. were evaluated by radiological methods and accompanying damage and complications were also investigated. Functional evaluation was performed in accordance with Friedman and Wyman criteria at the last follow-up.
Results
The average time for union of the femoral shaft was 22.5 weeks (12-32 weeks), and femoral neck was 13.1 weeks (8-20 weeks). There was no nonunion, and four femoral shaft fractures resulted in delayed union. There was one case of leg length discrepancy more than 2 cm long, but malalignment of more than 10 degrees was not observed. Avascular necrosis of the femoral head did not occur. Functional results were good in eight cases, fair in two cases, and poor in one case.
Conclusion
Treatment with reconstruction nailing after temporary K-wire fixation of the femoral neck is thought to be a good method which prevents neck displacement and has low complication rates.
Key words: Femoral shaft, Femoral neck, Temporary K-wire, Reconstruction nail

Financial support: None.

Conflict of interest: None.

REFERENCES

1. Bennett FS, Zinar DM, Kilgus DJ. Ipsilateral hip and femoral shaft fractures. Clin Orthop Relat Res, 1993;(296):168-177.
2. Delaney WM, Street DM. Fracture of femoral shaft with fracture of neck of same femur; treatment with medullary nail for shaft and Knowles pins for neck. J Int Coll Surg, 1953;19:303-312.
3. Swiontkowski MF. Ipsilateral femoral shaft and hip fractures. Orthop Clin North Am, 1987;18:73-84.
4. Garden RS. Low angle fixation in fractures of the femoral neck. J Bone Joint Surg Br, 1961;43:647-663.
5. Orthopaedic Trauma Association Committee for Coding and Classification. Fracture and dislocation compendium. J Orthop Trauma, 1996;10:Suppl 1. v-ix. 1-154.
6. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am, 1976;58:453-458.
7. Haidukewych GJ, Rothwell WS, Jacofsky DJ, Torchia ME, Berry DJ. Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. J Bone Joint Surg Am, 2004;86:1711-1716.
8. Friedman RJ, Wyman ET Jr. Ipsilateral hip and femoral shaft fractures. Clin Orthop Relat Res, 1986;(208):188-194.
9. Alho A. Concurrent ipsilateral fractures of the hip and shaft of the femur. A systematic review of 722 cases. Ann Chir Gynaecol, 1997;86:326-336.
10. Riemer BL, Butterfield SL, Ray RL, Daffner RH. Clandestine femoral neck fractures with ipsilateral diaphyseal fractures. J Orthop Trauma, 1993;7:443-449.
11. Stankewich CJ, Chapman J, Muthusamy R, et al. Relationship of mechanical factors to the strength of proximal femur fractures fixed with cancellous screws. J Orthop Trauma, 1996;10:248-257.
12. Bernstein SM. Fractures of the femoral shaft and associated ipsilateral fractures of the hip. Orthop Clin North Am, 1974;5:799-818.
13. Ashby ME, Anderson JC. Treatment of fractures of the hip and ipsilateral femur with the Zickel device: a report of three cases. Clin Orthop Relat Res, 1977;(127):156-160.
14. Schatzker J, Barrington TW. Fractures of the femoral neck associated with fractures of the same femoral shaft. Can J Surg, 1968;11:297-305.
15. Mackenzie DB. Simultaneous ipsilateral fracture of the femoral neck and shaft: report of 8 cases. S Afr Med J, 1971;45:459-467.
16. Swiontkowski MF, Hansen ST Jr, Kellam J. Ipsilateral fractures of the femoral neck and shaft. A treatment protocol. J Bone Joint Surg Am, 1984;66:260-268.
17. Bali K, Gahlot N, Aggarwal S, Goni V. Cephalomedullary fixation for femoral neck/intertrochanteric and ipsilateral shaft fractures: surgical tips and pitfalls. Chin J Traumatol, 2013;16:40-45.
18. Bedi A, Karunakar MA, Caron T, Sanders RW, Haidukewych GJ. Accuracy of reduction of ipsilateral femoral neck and shaft fractures--an analysis of various internal fixation strategies. J Orthop Trauma, 2009;23:249-253.
19. Wiss DA, Sima W, Brien WW. Ipsilateral fractures of the femoral neck and shaft. J Orthop Trauma, 1992;6:159-166.
20. Oh CW, Kim SY, Kyung HS, et al. Difficulties in the treatment for ipsilateral concomitent femoral neck & shaft fractures. J Korean Soc Fract, 2001;14:152-158.
21. Casey MJ, Chapman MW. Ipsilateral concomitant fractures of the hip and femoral shaft. J Bone Joint Surg Am, 1979;61:503-509.
22. Tsarouhas A, Hantes ME, Karachalios T, Bargiotas K, Malizos KN. Reconstruction nailing for ipsilateral femoral neck and shaft fractures. Strategies Trauma Limb Reconstr, 2011;6:69-75.

Fig. 1

(A) The entry point of the reconstruction nail lies transversely in the extension of the axis of the medullary canal, directly lateral to the tip of the greater trochanter (dot and arrow). We made a portal on the slight anterolateral of the original entry portal (circle). Temporary K-wire fixation was anterior to posterior of the femoral neck (black line). (B, C) C-arm image of the operation.

Fig. 2

(A, B) These X-rays show an ipsilateral femoral neck and shaft fracture in a 57-year-old female. (C, D) Immediate postoperative femoral radiographs after application of a Sirus® femoral nail. (E, F) Femur anteroposterior and lateral radiographs taken 6 months after the operation show complete bone union. (G) Leg length discrepancy developed.

Table 1

Summary Data of Ipsilateral Femoral Neck and Shaft Fracture

F: Female, M: Male, TA: Traffic accident, fx: Fracture, PCL: Posterior cruciate ligament, F&W: Friedman and Wyman criteria.

Figure & Data

REFERENCES

Citations

Citations to this article as recorded by

Cite

CITE: export Copy Download Format; Close

Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

Format:

RIS — For EndNote, ProCite, RefWorks, and most other reference management software
BibTeX — For JabRef, BibDesk, and other BibTeX-specific software

Include:

Citation for the content below
Citation and abstract for the content below

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

J Korean Fract Soc. 2015;28(1):23-29. Published online January 31, 2015

DOI: https://doi.org/10.12671/jkfs.2015.28.1.23

XML Download

Figure

We recommend

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

Fig. 1 (A) The entry point of the reconstruction nail lies transversely in the extension of the axis of the medullary canal, directly lateral to the tip of the greater trochanter (dot and arrow). We made a portal on the slight anterolateral of the original entry portal (circle). Temporary K-wire fixation was anterior to posterior of the femoral neck (black line). (B, C) C-arm image of the operation.

Fig. 2 (A, B) These X-rays show an ipsilateral femoral neck and shaft fracture in a 57-year-old female. (C, D) Immediate postoperative femoral radiographs after application of a Sirus® femoral nail. (E, F) Femur anteroposterior and lateral radiographs taken 6 months after the operation show complete bone union. (G) Leg length discrepancy developed.

Fig. 1

Fig. 2

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

Table 1

Summary Data of Ipsilateral Femoral Neck and Shaft Fracture

F: Female, M: Male, TA: Traffic accident, fx: Fracture, PCL: Posterior cruciate ligament, F&W: Friedman and Wyman criteria.

Table 1 Summary Data of Ipsilateral Femoral Neck and Shaft Fracture

F: Female, M: Male, TA: Traffic accident, fx: Fracture, PCL: Posterior cruciate ligament, F&W: Friedman and Wyman criteria.