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

Chang-Wug Oh; Jong-Keon Oh; Shin-Yoon Kim; Ki-Bong Cha; In-Ho Jeon; Byung-Chul Park; Woo-Kie Min; Tae-Gong Kim

doi:10.4055/jkoa.2007.42.3.380

Journal List > J Korean Orthop Assoc > v.42(3) > 1012669

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Oh, Oh, Kim, Cha, Jeon, Park, Min, and Kim: Retrograde Intramedullary Nailing for the Treatment of Ipsilateral Femoral Shaft and Neck Fracture

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2007; 42(3): 380-385.

Published online: 30 June 2007

DOI: https://doi.org/10.4055/jkoa.2007.42.3.380

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

Chang-Wug Oh, M.D., Jong-Keon Oh, M.D.^*, Shin-Yoon Kim, M.D.

, Ki-Bong Cha, M.D., In-Ho Jeon, M.D., Byung-Chul Park, M.D., Woo-Kie Min, M.D.

, Tae-Gong Kim, M.D.

Department of Orthopedic Surgery, Kyungpook National University Hospital, Deaegu, Korea.

^*Department of Orthopedic Surgery, Guro Hospital, Korea University, Seoul, Korea.

Address reprint requests to Chang-Wug Oh, M.D. Department of Orthopedic Surgery, Kyungpook National University Hospital, 50, Samdeok 2-ga, Jung-gu, Daegu 700-721, Korea. Tel: +82.53-420-5630, Fax: +82.53-422-6605, cwoh@knu.ac.kr

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.

Keywords: Femoral shaft fractures, Femoral neck fractures, Retrograde nailing

Figures and Tables

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).

Table 1

Femoral Shaft and Neck Fractures Treated by Retrograde Nailing Method

^*No 3 and 4, The same patient. In associated fracture, C means contralateral side; Neck fracture type, AO-OTA classification/Garden classification; Shaft fracture classification, AO-OTA classification/Winquist-Hansen classification; Function, according to criteria of Friedman and Wyman.

References

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.

3. Casey MJ, Chapman MW. Ipsilateral concomitant fractures of the hip and femoral shaft. J Bone Joint Surg Am. 1979. 61:503–509.

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.

5. Friedman RJ, Wyman ET Jr. Ipsilateral hip and femoral shaft fractures. Clin Orthop Relat Res. 1986. 208:188–194.

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.

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.

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.

11. Leung KS, So WS, Lam TP, Leung PC. Treatment of ipsilateral femoral shaft fractures and hip fractures. Injury. 1993. 24:41–45.

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.

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.

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.

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.

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.

TOOLS

ORCID iDs

Shin-Yoon Kim
https://orcid.org/http://orcid.org/0000-0002-5445-648X

Woo-Kie Min
https://orcid.org/http://orcid.org/0000-0003-2079-5085

Similar articles