J Korean Orthop Assoc.  2007 Jun;42(3):380-385. 10.4055/jkoa.2007.42.3.380.

Retrograde Intramedullary Nailing for the Treatment of Ipsilateral Femoral Shaft and Neck Fracture

Affiliations
  • 1Department of Orthopedic Surgery, Kyungpook National University Hospital, Deaegu, Korea. cwoh@knu.ac.kr
  • 2Department of Orthopedic Surgery, Guro Hospital, Korea University, Seoul, Korea.

Abstract

PURPOSE: To evaluate the results of the operative method for ipsilateral femoral shaft and neck fractures using retrograde nailing technique.
MATERIALS AND METHODS
Seventeen fractures (sixteen patients), followed-up more than 1 year, were included in this study. There were 14 men and 2 women, and the mean age was 44 years-old. According to the Winquist-Hansen classification, type II was most common with 11 cases. In femoral neck fractures, type B was most common with 13 cases according to AO-OTA classification and 6 of them were type II in Garden stage. After retrograde nailing of femoral shaft fractures, neck fractures were fixed by cannulated screw or dynamic hip screw.
RESULTS
The average time for union of shaft fractures was 27.3 (14-60) weeks. Nonunion occurred in five patients, who required bone grafts or changes of fixation. The average time for union of neck fractures was 11 (8-12) weeks. All united, except for one case of nonunion with avascuar necrosis, which was a Garden stage IV fracture. Functional results using Friedman-Wyman criteria were good in 16 cases, and fair in one. The only fair result was nonunion of the femoral neck, which had the joint arthroplasty.
CONCLUSION
Although the union rate of femoral shaft must be improved, retrograde nailing can provide an easy fixation and a favorable result for ipsilateral femoral neck fractures.

Keyword

Femoral shaft fractures; Femoral neck fractures; Retrograde nailing

MeSH Terms

Adult
Arthroplasty
Classification
Female
Femoral Neck Fractures
Femur Neck
Fracture Fixation, Intramedullary*
Hip
Humans
Joints
Male
Neck*
Necrosis
Transplants

Figure

  • Fig. 1 A 25-year-man suffered bilateral femoral fractures (A). Although the fracture of femoral neck was not evident on plain radiograph (B). Axial CT images showed it (arrows, C). Retrograde femoral nailing without reaming was done on the both femurs (D). After nailing, a vertical fracture line was seen on the right femoral neck (E). Then, three screws were fixed (F). At 4 month after operation, all fractures healed uneventfully (G & H).

  • Fig. 2 A 60-year-old man had a femoral shaft fracture and a severely displaced femoral neck fracture on the right leg (A). Retrograde nailing was done on the shaft fracture, and closed reduction was done on the neck fracture with three screws (B). At 3 month after operation, the screws of femoral neck drew back with nonunion of femoral shaft and neck (C). Arthroplasty and plate fixation were done (D).


Reference

1. Alho A. Concurrent ipsilateral fractures of the hip and femoral shaft: a meta-analysis of 659 cases. Acta Orthop Scand. 1996. 67:19–28.
2. Bucholz RW, Rathjen K. Concomitant ipsilateral fractures of the hip and femur treated with interlocking nails. Orthopedics. 1985. 8:1402–1406.
Article
3. Casey MJ, Chapman MW. Ipsilateral concomitant fractures of the hip and femoral shaft. J Bone Joint Surg Am. 1979. 61:503–509.
Article
4. Chen CH, Chen TB, Cheng YM, Chang JK, Lin SY, Hung SH. Ipsilateral fractures of the femoral neck and shaft. Injury. 2000. 31:719–722.
Article
5. Friedman RJ, Wyman ET Jr. Ipsilateral hip and femoral shaft fractures. Clin Orthop Relat Res. 1986. 208:188–194.
Article
6. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976. 58:453–458.
7. Hansen ST, Winquist RA. Closed intramedullary nailing of the femur. Kuntscher technique with reaming. Clin Orthop Relat Res. 1979. 138:56–61.
8. Jain P, Maini L, Mishra P, Upadhyay A, Agarwal A. Cephalomedullary interlocked nail for ipsilateral hip and femoral shaft fractures. Injury. 2004. 35:1031–1038.
Article
9. Kang S, McAndrew MP, Johnson KD. The reconstruction locked nail for complex fractures of the proximal femur. J Orthop Trauma. 1995. 9:453–463.
Article
10. Kim SJ, Oh CW, Ihn JC, et al. Retrograde intramedullary nail for femoral shaft fracture with limited indications. J Korean Fracture Soc. 2003. 16:45–51.
Article
11. Leung KS, So WS, Lam TP, Leung PC. Treatment of ipsilateral femoral shaft fractures and hip fractures. Injury. 1993. 24:41–45.
Article
12. Oh CW, Kim SY, Kyung HS, et al. Difficulties in the treatment for ipsilateral concomitent femoral neck . J Korean Fracture Soc. 2001. 14:152–158.
Article
13. Orthopaedic Trauma Association Committee for Coding and Classification. Fracture and dislocation compendium. J Orthop Trauma. 1996. 10:Suppl 1. S1–S153.
14. Swiontkowski MF, Hansen ST, Kellam J. Ipsilateral fractures of the femoral neck and shaft. A treatment protocol. J Bone Joint Surg Am. 1984. 66:260–268.
Article
15. Watson JT, Moed BR. Ipsilateral femoral neck and shaft fractures. complications and their treatment. Clin Orthop Relat Res. 2002. 399:78–86.
16. Wiss DA, Sima W, Brien WW. Ipsilateral fractures of the femoral neck and shaft. J Orthop Trauma. 1992. 6:159–166.
Article
17. Wolinsky PR, Johnson KD. Ipsilateral femoral neck and shaft fractures. Clin Orthop Relat Res. 1995. 318:81–90.
18. Wu CC, Shih CH. Ipsilateral femoral neck and shaft fractures. Retrospective study of 33 cases. Acta Orthop Scand. 1991. 62:346–351.
Article
19. Yang KH, Han DY, Park HW, Kang HJ, Park JH. Fracture of the ipsilateral neck of the femur in shaft nailing. The role of CT in diagnosis. J Bone Joint Surg Br. 1998. 80:673–678.
Full Text Links
  • JKOA
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr