Department of Orthopaedics, Shanghai First People's Hospital, Shanghai Jiaotong University, 100 Haining Rd., Hongkou District, Shanghai, China.
Injury. 2011 Jul;42(7):675-81. doi: 10.1016/j.injury.2010.11.013. Epub 2010 Dec 21.
Ipsilateral concomitant fractures of proximal extracapsular and distal femur are rare injuries and pose a great challenge for orthopaedics. In this study, we reviewed and examined the approaches and outcomes of this complex injury.
From August 2002 to January 2010, seven patients (six males and one female) with a mean age of 39 years (range, 20-48 years) were involved in the study. They had suffered from ipsilateral concomitant fractures of proximal extracapsular and distal femur, with two cases of unstable intertrochanteric fractures, three cases of subtrochanteric fractures and two cases of extracapsular femoral neck fractures. The distal femoral fractures were categorised based on the Arbeitsgemeinschaft für Osteosynthes (AO) classification: 2, A3; 2, C1; 2, C2 and 1, C3, and the proximal femoral fractures were stabilised via nailing, whilst the distal ones via less-invasive stabilisation system-distal femur (LISS-DF) plating in all six patients. In the one with the 'floating knee' injury, the subtrochanteric fracture was stabilised by reversed LISS-DF, and the distal one, by retrograde nailing. The healing of each femoral fracture was evaluated radiologically and clinically with follow-up. The functional outcomes were assessed through the Friedman and Wyman system.
The mean follow-up interval was 2 years (range, 1.5-3 years). Six femoral fractures healed uneventfully, whilst the one with the 'floating knee' injury developed a delayed union postoperatively due to metal failure in 6 months, and, eventually, a malunion with coxa vara deformity 1.5 years later. The clinical functions at the final follow-up were found to be good in five cases, and fair and poor in one case each.
The nailing of a proximal femoral fracture and an LISS-DF fixation of a distal one could be a reliable and effective approach to handle ipsilateral concomitant fractures of a proximal extracapsular and distal femur.
同侧股骨颈囊外近端和股骨远端同时骨折较为少见，给骨科医生带来了很大的挑战。本研究回顾并分析了这种复杂损伤的治疗方法和效果。
自 2002 年 8 月至 2010 年 1 月，共有 7 名患者（6 名男性，1 名女性）纳入研究，平均年龄 39 岁（范围 20-48 岁）。他们均为同侧股骨颈囊外近端和股骨远端同时骨折，其中 2 例为不稳定型股骨转子间骨折，3 例为股骨转子下骨折，2 例为股骨颈囊外骨折。股骨远端骨折根据 Arbeitsgemeinschaft für Osteosynthes（AO）分类：2，A3；2，C1；2，C2 和 1，C3；股骨近端骨折均通过髓内钉固定，而股骨远端骨折均通过微创固定系统-股骨远端（LISS-DF）钢板固定。在“浮膝”损伤的 1 例中，转子下骨折采用逆向 LISS-DF 固定，而远端骨折采用逆行髓内钉固定。通过影像学和临床随访评估每个股骨骨折的愈合情况。通过 Friedman 和 Wyman 系统评估功能结果。
平均随访时间为 2 年（范围 1.5-3 年）。6 例股骨骨折愈合顺利，而“浮膝”损伤的 1 例在术后 6 个月因内固定物失效导致延迟愈合，最终 1.5 年后出现畸形愈合伴髋内翻。最终随访时，5 例临床功能良好，1 例为一般，1 例为差。
股骨近端髓内钉固定和股骨远端 LISS-DF 固定是治疗同侧股骨颈囊外近端和股骨远端同时骨折的可靠有效方法。
