Ipsilateral femoral neck and shaft fractures: an overlooked association.

A total of 304 patients with injuries to the femoral shaft and ipsilateral hip presented between 1984 and 1990. Some 253 of them suffered fractures of the femoral shaft and dislocated hips or fractures of the acetabulum, and 51 of these sustained fractures of the femoral shaft and neck or trochanteric region. Of this latter group, 20 patients had a combination of femoral shaft and neck fractures, and 31 had a combination of femoral shaft and trochanteric fractures. All of the trochanteric injuries were demonstrated on the initial radiographs. However, in 11 of the patients with combined femoral shaft and neck fractures, the diagnosis was delayed by as much as 4 weeks. This delay related to the fact that these fractures tended not to separate in the initial evaluation period and that there was external rotation of the proximal femoral fragment due to the femoral shaft fracture. Good preoperative and, in particular, good postoperative radiography of the hip is essential to make the diagnosis. Although orthopedic surgeons have been aware of this combination of injuries since 1953, radiologists have not.