Ipsilateral hip and femoral shaft fractures.

Over a 20-year period, 24 patients were treated for ipsilateral hip and femoral shaft fractures. The majority of the hip fractures were extracapsular. All resulted from high-energy impaction injuries (motor vehicle accidents and falls from over 15 feet), with 25% being open. There were numerous associated injuries, many requiring multiple operations. One-third had an associated knee injury, with 75% occurring in those with extracapsular fractures. The diagnosis and treatment of three hip fractures were delayed, but all healed without avascular necrosis. Patients were treated by traction and various internal fixation methods, either alone or in combination. Fifty percent had major complications, predominantly patients treated only in traction. At a mean follow-up examination of 9.5 years, two-thirds had a good result and one-third a fair result. Those with extracapsular fractures had the same result as those with intracapsular fractures. Patients treated by fixation of one or both fractures had a significantly shorter hospital stay than those treated by traction alone. Extracapsular fractures have a high incidence (43%) of associated knee injuries. Treating both fractures with internal fixation allows early mobilization, easier patient care, fewer complications, and a shorter hospital stay. Despite the severity of multiple injuries, and the diversity of treatment with many complications, when stability is achieved the patients generally recover good function.