Treatment of Concurrent Ipsilateral Femoral Neck and Shaft Fractures

Hypothesis: Ipsilateral femoral neck and shaft fractures occur in 6-9% of femur fractures (1), however; there is no current consensus for treatment in the Orthopaedic literature. The treatment of ipsilateral femoral neck and shaft fractures pose a technically difficult problem with nearly 60 different treatment methods (2), but no agreement exists regarding the ideal treatment method. Material and Methods: We propose our treatment algorithm for treating these fractures, as well as our cohort of six patients treated with the aforementioned algorithm. For stable intertrochanteric fractures and femoral neck fractures, we recommend a dynamic sliding hip screw and a retrograde femoral nail. For unstable intertrochanteric fractures, we recommend treatment with a single implant (cephalomedullary nail). We treated six patients with combination hip and femoral shaft fractures at a level 1 trauma hospital from April 2016 through February of 2017. Patients ranged from 19-42 years of age. Results: All fractures remain anatomically reduced, and have either gone on to union or are progressing to union in the expected time frame. One complication, a stiff knee below the fractures, has been reported for which the patient is still undergoing treatment. Conclusions: Our research is ongoing, but to this point, we conclude that this is a reliable method for treating these very challenging fractures.