Concomitant ipsilateral femoral neck and femoral shaft fracture nonunions: a report of three cases and a review of the literature.

Ipsilateral femoral neck and femoral shaft fractures are rarely reported in the literature and represent a diagnostic and treatment challenge. Due to the possibility of missing a nonunion at either site, we recommend a high clinical suspicion and careful radiographic examination of both fracture sites. Because the development of nonunion at both sites is exceedingly rare, we report three cases of concomitant ipsilateral femoral neck and shaft nonunions that were treated by the senior author (KAE). Two patients were treated with a Pauwels osteotomy and a blade plate for the femoral neck nonunion and a reamed retrograde intramedullary nail for the shaft. One patient was treated with an antegrade reamed cephalomedullary intramedullary nail. All three patients' fractures united at a mean of 4.6 months and they are currently pain free and without physical limitations.