Surgical treatment of ipsilateral multi-level femoral fractures

Abstract

BackgroundConcurrent ipsilateral fractures of the proximal and shaft of the femur are rare complex fracture combinations. In this prospective cohort study, we evaluated clinical and radiological long-term results after operative treatment using several surgical strategies: the so-called “rendezvous” surgical technique, e.g., the combination of retrograde intramedullary nailing and dynamic hip screw (DHS) osteosynthesis, or the all-in-one device technique, e.g., long cephalomedullary nail, compared with two non-overlapping implants (e.g., conventional technique).MethodsIn a 10-year-period from 2004 to 2013, we treated 65 patients with complex ipsilateral multi-level femoral fractures. Median age was 45 years (range 19–90 years). Fractures were classified according to the AO/OTA classification. Four patients died during intensive care unit treatment due to multi-organ failure prior to definitive osteosynthesis. Clinical long-term outcome using the functional system of Friedman/Wyman as well as radiological outcome was evaluated 2 years after trauma (range 13–42 months).ResultsAll-in-one device was used in 36 patients, “rendezvous” technique in 9 patients, and the conventional technique in the remaining 16 patients. Two years after trauma, complete fracture healing was found in 57 out of 61 patients (“rendezvous”: 9, all-in-one device: 33, conventional: 15; p-value: 0.66). There was no significant difference regarding the complication rate in the cohort groups (“rendezvous”: 3, all-in-one device: 13, conventional: 5; p-value: 0.94). Using the functional assessment system of Friedman/Wyman 2 years after trauma, a good clinical result was found in 77.7% in the “rendezvous” group, in 77.8% in the all-in-one device group, and in 75% in the conventional group.ConclusionThe indication for operative stabilization of ipsilateral multi-level femoral fractures is considered an urgent and emergency procedure. Based on the successful long-term results of this study, we prefer the “rendezvous” technique with fracture stabilization from distally to proximally. Both fracture components require stable fixation. It is advisable to stabilize the shaft fracture primarily using external fixation (damage control orthopedics) and the proximal femoral fracture using early definitive internal fixation. In a second and staged operation, the external fixator is removed and the shaft fracture is stabilized using retrograde nail osteosynthesis with overlapping of the DHS and nail implants.

The rendezvous technique for the treatment of ipsilateral femoral neck and shaft fractures: A case series

“…The surgical technique is simple, economical and familiar to most orthopedic surgeons. von Ruden et al found no difference in outcome, comparing three techniques of fixation in a prospective cohort study of 65 patients, (mean follow up 2 years), but stated their preference for the rendezvous technique, other studies have shown similar successful outcomes supporting a dual implant approach [ [9] , [10] , [11] , [12] ].…”

Outcome Analysis of Dual Implant Osteosynthesis for Ipsilateral Proximal and Shaft Femur Fractures: Do We Need Cephalomedullary Nails?

“…Table 4 shows the Harris Hip Score. [1,8]. We studied 17 patients whose mean age was around 35.8 years that indicates that the incidence of such fractures due to high-energy trauma is mostly in the third and fourth decades of life.…”

“…The percentage of an additional proximal femur fracture accompanying a femoral shaft is approximately 1%-9% [ 1 ]. The mechanism of injury is often attributed to high-energy trauma transferring the force to the shaft as well as proximal femur [ 1 ].…”

“…The percentage of an additional proximal femur fracture accompanying a femoral shaft is approximately 1%-9% [ 1 ]. The mechanism of injury is often attributed to high-energy trauma transferring the force to the shaft as well as proximal femur [ 1 ]. Also, in such cases, there is a reported 10%-30% chance of missing the proximal femur fracture at initial evaluation [ 2 , 3 ].…”

A New Application of the Bioarchaeology of Care Approach: A Case Study from the Metal Period, the Philippines

“…The observed trauma likely resulted from a high impact force. In the modern clinical literature, transverse fractures of the femur, particularly segmented shaft fractures, are recorded in car accidents or falls from a height (von Rüden et al, ; Wu & Chen, ).…”