Reconstruction intramedullary nailing for ipsilateral femoral neck and shaft fractures: main factors determining prognosis.

BACKGROUND Ipsilateral femoral neck and shaft fractures are rare, and currently available treatment methods each have their own benefits and limitations. Although reconstruction intramedullary nails have been considered to be effective alternative, clinical outcomes vary significantly in reports. METHODS Thirty-seven consecutive adult patients with 37 combined fractures were treated with reconstruction intramedullary nails. All combined fractures were caused by high-energy injuries. Operations were performed as soon as possible after the patient's general condition was stabilized. Thirty combined fractures were treated within 24 hours, and the remaining seven were delayed for 3-13 days. Closed nailing was performed in all 37 subjects. Protected weight bearing was permitted as soon as possible postoperatively. RESULTS Thirty-two patients were followed- up for an average of 23 months (range, 12-45 months). Neck fractures healed in 90.6% of patients, and shaft fractures healed in 78.1% of patients (p = 0.11). The average union time was 16 weeks (range, 6-30 weeks) for the neck fractures and 35 weeks (range, 25-45 weeks) for the shaft fractures (p < 0.001). The average union time for the shaft were 34.2 weeks for the mildly-injured shaft group (Winquist I, II), and 42 weeks for the severely-injured shaft group (Winquist III, IV, segmental, p = 0.024). No neck or shaft malunion, femoral head osteonecrosis or wound infection occurred. CONCLUSIONS The outcome of ipsilateral femoral neck and shaft fracture depends primarily on the result of the treatment of the femoral shaft fracture. Severe shaft injuries had poor results. The main factor may be that the shaft fracture in a combined fracture sustains very high energy, and local soft tissues are severely compromised. More meticulous management of the shaft fracture, neck reduction and post-op protective weight bearing, may improve the outcome and reduce complications.