Ipsilateral proximal and shaft femoral fractures: Results of two treatment strategies

J Gómez Alcaraz; E Ajuria Fernández; I Auñón Martín; D Bustamante Recuenco; C Olaya González; A Capel Agúndez

doi:10.1016/j.recot.2023.06.006

Ipsilateral proximal and shaft femoral fractures: Results of two treatment strategies

Rev Esp Cir Ortop Traumatol. 2023 Sep-Oct;67(5):T354-T364. doi: 10.1016/j.recot.2023.06.006. Epub 2023 Jun 11.

[Article in English, Spanish]

Authors

J Gómez Alcaraz¹, E Ajuria Fernández², I Auñón Martín², D Bustamante Recuenco³, C Olaya González², A Capel Agúndez²

Affiliations

¹ Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España. Electronic address: Jorgega_93@hotmail.com.
² Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España.
³ Departamento de Cirugía Ortopédica y Traumatología, Hospital General de Nuestra Señora del Prado, Talavera de la Reina, Toledo, España.

PMID: 37311476
DOI: 10.1016/j.recot.2023.06.006

Abstract

Introduction: Ipsilateral proximal and shaft femoral fractures typically occur in young adults after high-energy trauma. No consensus exists regarding the optimal internal fixation device or surgical strategy for these complex fractures. Our main objective is to identify differences on outcomes and complications between patients treated with one or combined implants.

Material and method: This is a single-center retrospective cohort study in patients with associated fractures of the proximal (31 AO) and shaft femur (32 AO). We divided the patients into two groups according to the use of single (GroupI) or combined implants (GroupII). Demographic, clinical, radiological, surgical data and development of complications were collected.

Results: We identified 28 patients (19 men and 9 women) with an average age of 43years. We used an anterograde femoral nail in GroupI (17 patients) and a retrograde femoral nail or a plate associated with hip lag screws or sliding hip screw in GroupII (11 patients). Patients were followed up for 26.28 (9.12-62.88) months. Osteonecrosis of the femoral head, osteoarthritis, infection or nonunion was found in 9 patients (32%). No significant differences (P=.70) were found in complications between two groups or between definitive surgical fixation before or after the first 24h.

Conclusions: No differences in the development of complications or timing of definitive fixation were found between the use of one or combined implants in ipsilateral proximal femur and shaft fractures. Regardless of the implant chosen, an appropriate osteosynthesis technique is crucial, even so high complication rates are expected.

Keywords: Complex femur fracture; Femoral shaft fracture; Fractura bifocal de fémur; Fractura compleja de fémur; Fractura de diáfisis femoral; Fractura de fémur proximal; Fractura intracapsular y trocantérica; Intracapsular and trochanteric fracture; Proximal femur fracture; Segmental femur fracture.