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Russell Thomas A. M.D.
Techniques in Orthopaedics: January 1998
Controversies and Perils: PDF Only

Summary

The ipsilateral femoral neck and shaft fracture complex is problematic for orthopaedic surgeons because of the possibility of significant morbidity from avascular necrosis, femoral neck and shaft nonunion/malunion, and the complexity of surgery required to treat this entity. Forty-five years later, with almost 500 reports in the literature since this entity was first described, there is now substantial evidence for the techniques that will yield the highest success rate. Intraoperative scrutiny of the femoral neck before and after surgical stabilization of femoral shaft fractures with multiple views using an intraoperative image intensifier is required to avoid a missed diagnosis. Surgical stabilization of both fractures should be undertaken as soon as medically possible. Both fractures must be sequentially reduced, provisionally and definitively stabilized at the same operative session. The displaced femoral neck should be reduced into an anatomic or slight valgus position and provisionally stabilized with an open anterior approach to the femoral neck before the reduction and stabilization of the femoral shaft fracture. The current literature supports the recommendation for either a Reconstruction-type interlocking nail with a 130-135° neck shaft angle and proximal sliding lag screws or first-generation femoral interlocking nailing with accessory lag screw femoral neck fixation as the procedures with the lowest complication rates for both fractures.

Address correspondence and reprint requests to Thomas A. Russell, MD, Memphis Orthopaedic Group, 1325 Eastmoreland Ave., Suite 260, Memphis, TN 38104, U.S.A.

© Williams & Wilkins 1998. All Rights Reserved.