Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
Department of Orthopaedics, Primus Super Speciality Hospital, New Delhi, India.
Eur J Orthop Surg Traumatol. 2023 May;33(4):803-809. doi: 10.1007/s00590-021-03199-3. Epub 2022 Feb 4.
Uncommon but increasingly diagnosed, ipsilateral femoral neck and shaft fracture represents a complex injury pattern with challenging management. The conundrum involves optimal diagnostic modality, timing of surgery, sequence of fixation, and the choice of implant.
A retrospective review was conducted at a Level-I trauma centre to assess the outcome of concomitant femoral neck and shaft fractures managed with various implants and attempt to provide solutions to the aforementioned queries. The time between injury and definitive surgery, choice of implant, sequence of fixation, time to fracture union, and complications were documented and analyzed.
A total of 46 patients were included in the study wherein associated neck fracture was identified preoperatively in 93.5% of patients. In patients with isolated limb fractures, the mean time to surgery was 16.7 ± 5 h whereas patients with polytrauma witnessed an average delay of 4.6 days before fracture fixation. 72% of patients were managed by dual implants and in the remaining both the fractures were addressed using a single implant with no union time difference amongst implants. The mean time to the union for neck fracture was 21.7 weeks and 24.2 weeks for shaft femur fracture. 21.7% patients developed delayed union of fracture shaft femur and infection complicated 11% shaft fractures.
Although, 6% neck fractures were missed in the series, we advocate that careful pre/intra/post-operative fluoroscopic evaluation of the femoral neck along with a low threshold for a pre-operative CT scan remains the optimal diagnostic modality while avoiding universal employment of computed tomography (CT). With fracture union being unaffected by implant choice, authors suggest that anatomical fixation of the femoral neck is of paramount importance followed by restoration of the length, alignment and rotation of the femoral shaft, and the implant selection primarily depends on surgeon's experience and the pattern of injury.
同侧股骨颈和股骨干骨折虽不常见但诊断率逐渐增高，其代表了一种复杂的损伤模式，治疗颇具挑战性。该难题涉及到最佳诊断方式、手术时机、固定顺序以及植入物选择。
在一家一级创伤中心进行了回顾性研究，以评估采用各种植入物治疗的同时性股骨颈和股骨干骨折的结果，并尝试为上述疑问提供解决方案。记录并分析了受伤与确定性手术之间的时间、植入物的选择、固定顺序、骨折愈合时间和并发症。
共有 46 名患者纳入本研究，其中 93.5%的患者术前发现合并股骨颈骨折。在单纯肢体骨折的患者中，手术平均时间为 16.7±5 小时，而多发伤患者在骨折固定前平均延迟 4.6 天。72%的患者采用双植入物治疗，其余患者均采用单植入物治疗，两种植入物的愈合时间无差异。颈骨折的平均愈合时间为 21.7 周，股骨干骨折为 24.2 周。21.7%的患者发生股骨干骨折延迟愈合，11%的股骨干骨折合并感染。
尽管该系列研究中漏诊了 6%的颈骨折，但我们主张，应在术前进行 CT 扫描，仔细进行术前、术中、术后的股骨颈荧光透视评估，避免常规使用 CT。由于植入物选择不影响骨折愈合，作者建议，应首先注重股骨颈的解剖固定，然后再恢复股骨干的长度、对线和旋转，植入物的选择主要取决于外科医生的经验和损伤模式。
