Chi-Chuan Wu1. 1. Department of Orthopedics, Chang Gung Memorial Hospital, 5 Fu-Hsin St., 333 Kweishan, Taoyuan, Taiwan. ccwu@mail.cgu.edu.tw
Abstract
INTRODUCTION: Ununited ipsilateral femoral neck and shaft fractures are very rare, and their treatment is very complicated. Until now, no single treatment method has been recommended in the literature. MATERIALS AND METHODS: Eighteen patients sustained femoral shaft fractures, which were treated with reamed intramedullary nails but remained ununited. Concomitant, ipsilateral femoral neck fractures were neglected for 2-16 months (median 4 months). The neck fractures were treated by subtrochanteric valgus osteotomy with sliding compression screw stabilization, and the shaft fractures by dynamic compression plating with supplementary cancellous bone grafting. Postoperatively, ambulation with protected weight-bearing was encouraged as early as possible. RESULTS: Sixteen patients were followed up for at least 2 years (range 2-7 years), and all fractures healed. The neck fracture healed at 3.7+/-0.6 months ( p<0.001), the osteotomy site at 5.3+/-0.9 months, and the shaft fracture at 5.6+/-1.0 months ( p=0.07). All patients could walk without aids. Complications included one osteonecrosis of the femoral head (6.3%), which was followed up regularly without further treatment. CONCLUSION: The described technique provided a high union rate with a low complication rate. In addition, the surgical procedure was relatively simple. Therefore, it might be considered for all indicated cases.
INTRODUCTION: Ununited ipsilateral femoral neck and shaft fractures are very rare, and their treatment is very complicated. Until now, no single treatment method has been recommended in the literature. MATERIALS AND METHODS: Eighteen patients sustained femoral shaft fractures, which were treated with reamed intramedullary nails but remained ununited. Concomitant, ipsilateral femoral neck fractures were neglected for 2-16 months (median 4 months). The neck fractures were treated by subtrochanteric valgus osteotomy with sliding compression screw stabilization, and the shaft fractures by dynamic compression plating with supplementary cancellous bone grafting. Postoperatively, ambulation with protected weight-bearing was encouraged as early as possible. RESULTS: Sixteen patients were followed up for at least 2 years (range 2-7 years), and all fractures healed. The neck fracture healed at 3.7+/-0.6 months ( p<0.001), the osteotomy site at 5.3+/-0.9 months, and the shaft fracture at 5.6+/-1.0 months ( p=0.07). All patients could walk without aids. Complications included one osteonecrosis of the femoral head (6.3%), which was followed up regularly without further treatment. CONCLUSION: The described technique provided a high union rate with a low complication rate. In addition, the surgical procedure was relatively simple. Therefore, it might be considered for all indicated cases.