Ipsilateral femoral shaft and hip fractures.

A midshaft femoral fracture in a high-energy trauma victim should prompt the orthopedist to search carefully for an ipsilateral fracture of the femoral neck. This fracture will be present in 5 per cent of patients, and the incidence may be increasing. Management of the femoral neck fracture should include emergent capsulotomy, anatomic reduction, and rigid fixation with compression. Management of the femoral shaft should not interfere with these goals because of the risk of post-traumatic necrosis of the femoral head. Successful methods of management of the femoral shaft fracture have included compression plating, retrograde Kuntscher nailing, and interlocking nails. Approaches to the treatment of concomitant intertrochanteric and femoral shaft fractures should be selected according to the skill and experience of the surgeon and the availability of equipment.