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

doi:10.22271/ortho.2017.v3.i3k.116

Cited by 3 publications

(3 citation statements)

References 15 publications

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“…The available data on the success in treating FN-FD fractures is limited and mostly derives from relatively small series. As previously published, fracture union is observed within 28 weeks at the level of the neck and within 39 weeks at the femoral shaft ( 36 , 37 , 44 , 45 , 46 , 47 , 48 ). The incidence of avascular necrosis (AVN) of the femoral head is reported to be up to 14% using a single implant in contrast to up to 26% if two implants were used.…”

Section: Discussionsupporting

confidence: 71%

“…The incidence of avascular necrosis (AVN) of the femoral head is reported to be up to 14% using a single implant in contrast to up to 26% if two implants were used. The surgical site infection rate was independent of the technique used by up to 10% ( 45 , 46 , 48 ).…”

Section: Discussionmentioning

confidence: 96%

“…The existing comparative studies suffer from the large variation of different methodologies and the absence of randomization. The use of cephalomedullary nails ( 44 , 47 ), proximal femoral nail (PFNA) ( 37 , 45 ), or reconstruction nails ( 36 , 46 , 48 ) was compared by different authors in different decades of practice to the outcome and complication rate of dual devices in the form of compression diaphyseal plates with free lag screws for the neck (36, 37, 44, 45, 46, 47, 48), or retrograde nails with dynamic hip screws ( 36 , 37 , 45 , 47 , 48 ), or a combination of antegrade femoral nails with ‘miss the nail’ lag screws for the neck fracture ( 44 , 48 ).…”

Section: Discussionmentioning

confidence: 99%

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Surgical fixation of ipsilateral femoral neck and shaft fractures: a matter of debate?

Bastian,

Ivanova,

Mabrouk

et al. 2023

EFORT Open Reviews

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Segmental femoral fractures represent a rare but complex clinical challenge. They mostly result from high-energy mechanisms, dictate a careful initial assessment and are managed with various techniques. These often include an initial phase of damage control orthopaedics while the initial manoeuvres of patient and soft tissue resuscitation are employed. Definitive fixation consists of either single-implant (reconstruction femoral nails) or dual-implant constructs. There is no consensus in favour of one of these two strategies. At present, there is no high-quality comparative evidence between the various methods of treatment. The development of advanced design nailing and plating systems has offered fixation constructs with improved characteristics. A comprehensive review of the existing evidence with a step-by-step description of these different definitive fixation strategies based on three case examples was conducted. Furthermore, the rationale for using single vs dual-implant strategy in its case is presented with supportive references. The prevention of complications relies mainly on the strict adherence to basic principles of fracture fixation with an emphasis on careful preoperative planning, the quality of the reduction, and the application of soft tissue-friendly surgical methods.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Surgical fixation of ipsilateral femoral neck and shaft fractures: a matter of debate?

Bastian,

Ivanova,

Mabrouk

et al. 2023

EFORT Open Reviews

View full text Add to dashboard Cite

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Double fractures of the femur: a review of 16 patients

Angelini

Mavrogenis

Crimì

et al. 2021

Eur J Orthop Surg Traumatol

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Background Double ipsilateral femoral fractures account for 1-9% of femoral fractures. There is no clear advantage between single or double implant osteosynthesis. We present a series of patients with double ipsilateral femoral fractures, to address the challenges in treatment, namely the implants for osteosynthesis and complications of treatment. Materials and methods We retrospectively studied 16 patients (7 men, 9 women; mean age, 51 years) treated from January 2015 to December 2018. Motor vehicle accidents were the leading cause of injury. Types of fractures were pertrochanteric and shaft (6), pertrochanteric and distal (2), double shaft (3), neck and shaft (2), neck and distal (1), shaft and distal (1), and triple fracture including a pertrochanteric, shaft and distal (1). In five patients, two different implants were used (plate and screws, cannulated hip screws, femoral nail), whereas in 11 patients a long femoral nail was used. Results Fourteen patients experienced union at a mean of 3 months (2-6 months). Two patients experienced nonunion: both had plate and screws osteosynthesis. One patient died 15 days after admission from polytrauma and another patient experienced central venous catheter thrombosis and pneumonia. Surgical complications (2 patients) included a thigh skin necrosis, and external fixator pin tract infection/infected non-union. Weight-bearing was delayed in all patients; full weight-bearing was allowed in 11 patients at 4 months postoperatively, and in four patients at 5 months. Conclusion Due to the rarity and the difficulty of standardization of double ipsilateral femoral fractures, there is variable information on the optimal osteosynthesis of the fractures and the outcome of the patients. It seems that closed reduction and long hip nailing is the treatment of choice, with few complications.

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Comparison of reconstruction nails versus dual implants in the treatment of ipsilateral femoral neck and shaft fractures in adults: a meta-analysis and systematic review

Zhao,

Li,

Liu

et al. 2023

BMC Musculoskelet Disord

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Objective There is no consensus on the optimal treatment for ipsilateral femoral neck and shaft fractures. This meta-analysis aims to assess the effectiveness of reconstruction nails and dual implants in treating ipsilateral femoral neck and shaft fractures to provide a basis for decision-making when selecting the optimal approach. Methods Relevant articles were retrieved from Pubmed, Embase, and Cochrane databases using the keywords "neck of femur", "shaft" and "fracture fixation" from inception until November 17, 2022. The screening process of the studies was conducted independently by two assessors, who assessed each study's eligibility and two assessors assessed the quality. Then compared differences in outcome measures using RevMan 5.3 software. Results A total of ten retrospective cohort studies were included. There were no significant differences in union time, union rate, union-related complications (malunion, nonunion, delayed union) of femoral neck and shaft fractures, osteonecrosis of the femoral head, and functional outcomes (Friedman-Wyman scoring system) (P > 0.05). Conclusion Our pooled estimates indicated that reconstruction nails and dual implants for ipsilateral femoral neck and shaft fractures could yield satisfactory surgical results, and that there is no difference between the two treatment methods. Trial registration This meta-analysis was registered on the PROSPERO website (registration number: CRD42022379606).

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

Cited by 3 publications

References 15 publications

Surgical fixation of ipsilateral femoral neck and shaft fractures: a matter of debate?

Surgical fixation of ipsilateral femoral neck and shaft fractures: a matter of debate?

Double fractures of the femur: a review of 16 patients

Comparison of reconstruction nails versus dual implants in the treatment of ipsilateral femoral neck and shaft fractures in adults: a meta-analysis and systematic review

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