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Surgeons should evaluate high-energy fractures for combined ipsilateral femoral neck, shaft fracture
In patients who have sustained high-energy femoral neck shaft fractures, researchers recommended that surgeons carefully evaluate the femoral neck for combined ipsilateral femoral neck and shaft fractures, despite the rarity of their occurrence.
According to the researchers, poor-quality radiographs; the presence of overlying objects, such as traction splits that obscure the femoral neck; a lack of dedicated hip views; and the presence of distracting injuries and other associated serious injuries can limit accurate diagnosis of combined ipsilateral femoral neck and shaft fractures. Previous research has shown the incidence of missed femoral neck fractures can be reduced with use of a thin-cut CT scan and dedicated anteroposterior internal rotation radiographs of the femoral neck.
David J. Hak
An examination of the intraoperative lateral hip fluoroscopic view and obtaining dedicated anteroposterior internal rotation views of the hip at follow-up can also reduce the incidence of missed femoral neck fractures. Use of both intraoperative and postoperative imaging is important to detect nondisplaced femoral neck fractures in association with femoral shaft fractures, according to the researchers.
Through their review, the researchers found treatment options include:
- reconstruction nail;
- antegrade nail and separate screws adjacent to the nail;
- femoral neck screws and retrograde femoral nail;
- sliding hip screw with or without additional derotation screw and retrograde femoral nail;
- femoral neck screws and plate fixation of the shaft; and
- sliding hip screw with or without additional derotation screw and plate fixation of the shaft.
“Although there are a number of different options available for management of this challenging injury, most authors recommend that priority be given to anatomic reduction and optimal stabilization of the femoral neck fracture because nonunion, malunion or avascular necrosis of this injury is more difficult to successfully treat,” the researchers wrote. – by Casey Tingle
Disclosures: Hak is a paid consultant for Invibio, RTI Biologics and Merck. Please see the full study for all other authors’ relevant financial disclosures.