Cephalomedullary nails in the management of ipsilateral neck and shaft fractures of the femur--one or two femoral neck screws?

This was a prospective study of 43 consecutive cases of combined ipsilateral femoral neck and shaft fractures treated with cephalomedullary nails. Sequential clinicoradiological evaluation of all high-energy femoral shaft fractures to detect associated ipsilateral neck fracture improved diagnosis. All but 1 of 35 cases included in the study achieved union of both fractures and excellent or good functional outcome. Mean Harris Hip Score at the last follow-up was 92+/-4 in single-neck screw configurations, and 94+/-3 for two-neck screw cephalomedullary nails which had better tip-apex distance. Mean sliding of the neck screw was 5+/-2mm with single-neck and 3+/-2mm with two-neck screw constructs. In six cases shortening was <1cm; 22 had delayed union of the shaft fracture, but only four of these needed additional surgery. Early aggressive fixation of both fractures using a cephalomedullary nail with the least possible surgical trauma is the key to success in these polytrauma cases.