Ipsilateral fractures of the femoral neck and shaft.

The management of ipsilateral fractures of the femoral neck and shaft has proved to be a challenge to the orthopaedist. Most major institutions have treatment protocols that emphasize early rigid stabilization of the femoral-neck fracture to minimize the incidence of avascular necrosis of the femoral head. Since 1985, the authors' protocol has been to reduce and stabilize the femoral-neck fracture anatomically, followed by treatment of the femoral-shaft fracture. In 1990, we began treating this segmental fracture pattern with reconstruction nails. This study reviews the cases of 11 patients treated at the Medical College of Georgia Hospital from November 1985 to March 1992. Nine of the 11 underwent surgery within 12 hours of injury; 4 of these patients were treated with reconstruction nails. The mean follow-up was 2 years. Seven of the 11 had a good functional outcome, whereas 4 had a fair outcome. The results indicate that patients with ipsilateral fractures of the femoral neck and shaft can obtain good results when early (< 12 hours) rigid anatomic stabilization of the femoral neck is performed. The authors recommend utilizing a reconstruction nail for stabilizing this dual fracture whenever possible.