Ipsilateral Femoral Neck & Shaft Fractures - Everything You Need To Know - Dr. Nabil Ebraheim

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Case description

Dr. Ebraheim’s educational animated video describes the ipsilateral femoral neck and shaft fractures of the femur. Ipsilateral Femoral Neck & Shaft Fractures are a high energy trauma that occurs in about 1-6% of cases (Rare but important). Neck fractures may be missed in about 20-30%. Most of associated neck fractures are vertical Pauwel III classification. Basicervical and nondisplaced. X –ray diagnosis is difficult due to failure to take good quality x-rays for the hip because the fracture is not displaced. Also, because the hip is externally rotated from the fractured femur, it is hiding the fracture of the neck. CT scan thin cuts may detect the neck fracture prior to surgery. Get x-rays of the hip before, during and after fixation of fracture of the shaft of the femur. The fracture is usually occult and it can be discovered at the time of surgery or after fixation. Risk factors •Acetabular fracture and patellar fracture •Comminuted mid-shaft fracture, fracture secondary to axial loading, check the hip for a fracture. Because of the potential complications of AVN and nonunion, femoral neck fractures is given priority in the treatment. Options for treatment: Femoral neck fractures must have an anatomic reduction, open or closed, and stable fixation. One or two devices could be used. Two different devices are usually used. Open reduction of the hip can be done by the Watson Jones approach or by limited Smith Peterson approach. Timing of discovery of the femoral neck fracture may decide the available options for treatment. Fracture neck missed and discovered after surgery If the patient complains of hip pain after IM rodding of the femur, get hip x-rays to rule out hip fracture. Post operative 15 degrees of internal rotation of the hip before walking the patient may discover the fracture. If you discover the fracture and the patient already has an IM rod for the fractured femur, reduce the neck and put screws anterior to the rod. If the neck is not displaced, you could use a cephalomedullary nail. This technique is unpredictable and rarely used, the fracture may displace. The use of IM nailing for both fracture may lead to malreduction of one of the fractures. The femoral neck may displace and go into varus. The fixation may fail and nonunion may occur. Neck fracture is displaced Fracture must be reduced anatomic and fixed with screws or compression hip screws. Focus on the neck to gain anatomic reduction. The femur shaft can be fixed with a retrograde nail or with a plate. There is less incidence of avascular necrosis in this type of fracture neck than in isolated neck fractures due to dissipation of the force of the shaft of the femur (5% AVN). In general fix the neck fractures first and use a different device for the femur fractures. 

tags: ipsilateral femoral neck fracture shaft fracture bone fracture x-ray hip pain


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Maciej Dobosz

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