Accuracy of reduction of ipsilateral femoral neck and shaft fractures--an analysis of various internal fixation strategies.

OBJECTIVES

Controversy surrounds the selection of the proper internal fixation device for treatment of ipsilateral fractures of the femoral neck and shaft. The purpose of this study was to review a large consecutive series of patients to learn more about the efficacy of various internal fixation strategies in maintaining an excellent reduction of both fractures.

DESIGN

Retrospective multicenter.

SETTING

Two level 1 trauma centers.

PATIENTS/

PARTICIPANTS

Between 1989 and 2006, 40 consecutive patients underwent internal fixation of an ipsilateral femoral neck and shaft fracture at 2 level 1 trauma centers. Thirty-seven of 40 patients (95%) with a mean age of 38 years (range, 18-73 years) had sufficient radiographs to assess accuracy of fracture reduction.

INTERVENTION: Patients with displaced femoral neck fractures were typically treated with 2 separate devices and underwent formal open reduction of the femoral neck. Patients with nondisplaced neck fractures were treated with closed reduction and fixation with either 1 or 2 devices based on surgeon preference. The femoral neck fractures were displaced in 21 patients and nondisplaced in 16 patients. Nine fractures were addressed with a single implant and 28 with 2 separate devices.

MAIN OUTCOME MEASUREMENTS: Radiographs were reviewed to evaluate the quality of reduction of both fractures. Clinical follow-up of 12 months or greater was available on 16 patients with a mean of 34.4 months (range, 12-112 months).

RESULTS

Thirty-six of 37 patients (97%) obtained or maintained excellent femoral neck reductions. The only poor neck reduction occurred in the case of a displaced femoral neck-shaft fracture treated with a single cephalomedullary implant. Thirty-five excellent (95%) and 2 poor shaft reductions were obtained. Both shaft malreductions occurred in comminuted shaft fracture patterns in which a single cephalomedullary device was used for both fractures. Performing internal fixation of both fractures with a single cephalomedullary device led to a significantly higher rate of fracture malreduction of one of the fractures (3 of 9) as compared with a 2-device strategy (0 of 28) (P = 0.01).

CONCLUSIONS

Open reduction and internal fixation of a displaced femoral neck fracture followed by retrograde nailing of the femoral shaft allowed accurate reduction and uneventful union of both fractures in most patients. The use of a cephalomedullary device to address both fractures simultaneously led to a significantly higher rate of malreduction of one of the fractures.