Occult femoral neck fractures in ipsilateral femoral shaft and patellar fractures: A case series about diagnostic challenges and proposed strategies.

This case series presents two patients with high-energy trauma resulting in ipsilateral femoral shaft and patellar fractures. Preoperative CT imaging suggested a bone cyst but failed to detect an associated femoral neck fracture, which was also missed during intraoperative fluoroscopy and identified only on postoperative review. Both patients underwent revision surgery involving repositioning of the proximal intramedullary nail locking screws to achieve fixation directed into the femoral neck. At the 6-month follow-up, fracture healing was satisfactory with no signs of avascular necrosis of the femoral head. This report highlights the risk of missed occult femoral neck fractures in high-energy trauma and proposes a diagnostic workflow including MRI screening for femoral neck injury in cases of high-energy lower limb trauma. The efficacy of revision nailing with recon locking is also demonstrated.