TY - JOUR
T1 - Reconstruction intramedullary nailing for ipsilateral femoral neck and shaft fractures
T2 - Main factors determining prognosis
AU - Tsai, Ming Chian
AU - Wu, Chi Chuan
AU - Hsiao, Chih Wen
AU - Huang, Jau Wen
AU - Kao, Hsuan Kai
AU - Hsu, Yu Tun
PY - 2009/9
Y1 - 2009/9
N2 - 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.
AB - 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.
KW - Ipsilateral femoral neck and shaft fractures
KW - Prognosis
KW - Reconstruction intramedullary nail
UR - http://www.scopus.com/inward/record.url?scp=70449422019&partnerID=8YFLogxK
M3 - 文章
C2 - 19840514
AN - SCOPUS:70449422019
SN - 0255-8270
VL - 32
SP - 563
EP - 573
JO - Chang Gung Medical Journal
JF - Chang Gung Medical Journal
IS - 5
ER -