Ipsilateral neck and shaft fractures of the femurs

Hume, Eric; Catalano, John B.

doi:10.1016/1048-6666(94)90058-2

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…Most neck fractures were clustered at or near the base of the neck, a fracture type that has been reported by few authors [48,49,51,117], differing from the spiral type commonly seen in isolated femoral neck fractures [10,23,49,118]. This shear fracture of the femoral neck is a unique pattern related to the mechanism of production of this combined injury [3,16,20,119], and its mean frequency in the review series was 60.…”

Section: Discussionmentioning

confidence: 91%

“…Most of these have been retrospective reports of small case series. Some were literature reviews [2,9,[12][13][14][15][16][17][18][19][20][21], and a ISSN: 2469-5777 of ipsilateral neck fractures in the existing series of femoral shaft fractures, and there is a belief that this incidence may be increasing [9,19,22,23]. The anatomic patterns of the femoral neck fractures and the frequency of some epidemiologic factors are reported with considerable variation.…”

Section: Introductionmentioning

confidence: 99%

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Epidemiology and Diagnosis of Ipsilateral Femoral Neck and Shaft Fractures: A Systematic Review of 1761 cases in 1758 Patients (I.1990-VI.2015)

Barquet¹

2015

Trauma Cases Rev

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Objectives: Ipsilateral femoral neck and shaft fractures [IFNSF] are uncommon. The existing literature is characterized by a diversity of small reports with a lack of consensus. We performed a systematic review to examine the epidemiology and diagnosis of this injury.Methods: Nineteen databases were used to find articles published between January 1990 and June 2015 with no language restriction. Inclusion criteria were studies describing a minimum of five patients 16 years old or older with acute IFNSF and adequate extractable data. Exclusion criteria were trochanteric fracture and malignancy at the time of retrieval. A series from the senior authors was also included. Results:The selected 85 studies together with our series produced a total of 1758 patients with 1761 cases. The frequency of IFNSF in all femoral shaft fractures was 3, 37%, mostly resulting from high energy trauma. The typical patient was a young adult male; the mean frequency of multiple injuries was 73.5 and ipsilateral knee injuries it was 27.3. Most neck fractures originated at the base of the neck, and the mean frequency of variable cranial exit point was 6 for sub capital, 35.5 for midcervical and 58.3 for basicervical. The mean proportion of vertical shear fractures was 60. The mean frequency of undisplaced neck fractures was 57.4. Shaft fractures were most often in the middle third -mean 74.4-and they were open in a mean of 18.3. The neck fracture was diagnosed postoperatively in a mean proportion of 8.7 of the cases. Diagnosis of the femoral neck fracture using only X-rays in the period 1990-2000 failed to demonstrate the fracture in 14% of the cases; a more careful scrutiny of the radiographs and other views improved diagnosis leaving 7.88% of the cases without diagnosis in the period 2001-2015. The use of radiographs and CT scans and a protocol of radiographs, CT scans and intraoperative fluoroscopy reduced misdiagnosis to 4.94% and 6.34%, respectively. Conclusions:This systematic review describes epidemiology of IFNSF, characterizes the usual pathoanatomy of the injuries and shows the influence of imaging protocols in improving diagnosis.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Epidemiology and Diagnosis of Ipsilateral Femoral Neck and Shaft Fractures: A Systematic Review of 1761 cases in 1758 Patients (I.1990-VI.2015)

Barquet¹

2015

Trauma Cases Rev

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“…A large variety of implants and surgical techniques have been described for exchange nailing because of non-union 28 , 29 , 30 or femoral nail breakage, 30 , 31 , 32 , 33 but none has been established as an undisputed gold standard. 34 , 35 Treatment becomes even more challenging when there is a combination of ipsilateral fractures of the femoral shaft and neck, 22 , 36 as the preferred implant for one fracture might make reduction and fixation of the other even more difficult. 37 , 38 As this was the case with our patient, we decided to aim for a customized solution using the resources that were available such as a traction table for reduction.…”

Section: Discussionmentioning

confidence: 99%

“Kissing Nail Technique” for the exchange of intramedullary implants in adjacent peri-implant fractures

Melcher

Delhey

Birkenmaier

et al. 2017

Acta Orthopaedica et Traumatologica Turcica

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One third of the people aged 65 years and over fall every year, and 1–5% of these falls result in a fracture. For these people, history of fracture and surgery become a risk factor for recurrent falls. In osteoporotic patients, repeated fractures often require several osteosynthetic procedures within a short time frame. Despite the lack of biomechanical studies, clinical experience suggests that additional fractures adjacent to implants occur because of the difference in stiffness between the metallic implant and the osteoporotic bone. This requires customized fixation techniques to ensure stability.The technique was first performed in an 81-year old female patient presenting with a dislocated proximal femoral fracture at the tip of a previously implanted distal femoral nail (DFN), and non-union of the old fracture. For this technique, the DFN was advanced until it passed the proximal fracture, thereby reducing both fractures, while a lateral femoral nail (LFN), extra-long and 3 mm thicker than the DFN, was introduced and advanced distally. The LFN was implanted in a “kissing nail technique,” meaning the tips of the two nails were touching each other, and all fracture fragments were held in functional reduction. The DFN was slowly pulled backwards and fragment stability was maintained, while both nails passed the distal non-union.The Kissing Nail Technique allows simple, safe and fast reduction of all instable fragments, precise and easy positioning of the proximal entry point by the retrograde guide wire, a minimally invasive procedure, and stable fixation of a periprosthetic fracture.We found this new customized procedure accommodating to the unique anatomical features of a single patient, that can be applied as a strategy especially for osteoporotic patients with periprosthetic fractures.

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Ipsilateral proximal and shaft femoral fractures: spectrum of injury involving the femoral neck

Shuler¹,

Gruen²,

Ditano³

et al. 1997

Injury

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Ipsilateral neck and shaft fractures of the femurs

Cited by 3 publications

References 11 publications

Epidemiology and Diagnosis of Ipsilateral Femoral Neck and Shaft Fractures: A Systematic Review of 1761 cases in 1758 Patients (I.1990-VI.2015)

Epidemiology and Diagnosis of Ipsilateral Femoral Neck and Shaft Fractures: A Systematic Review of 1761 cases in 1758 Patients (I.1990-VI.2015)

“Kissing Nail Technique” for the exchange of intramedullary implants in adjacent peri-implant fractures

Ipsilateral proximal and shaft femoral fractures: spectrum of injury involving the femoral neck

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