Iraqi Journal of Medical Sciences








Vol. 13 Issue 1 January - March / 2015
Published on website | Date : 2016-03-22 22:42:13

PROSPECTIVE DESCRIPTIVE STUDY OF SHORT-TERM RESULT OF IPSI-LATERAL FRACTURE NECK SHAFT FEMUR TREATED BY MODIFIED TRADITIONAL ANTE-GRADE INTERLOCKING NAILING AND LAG SCREW

Zaid A.A. Alshemmari, Ahmed I. Joda


Abstract

Background: Ipsilateral concomitant fractures of the femoral neck and femoral shaft are unusual (incidence 5-6%), and pose a difficult treatment problem. This injury usually resulting from high energy trauma, road traffic accident and fall from height. Many treatment methods have been invented and adopted, controversy exists about the optimal methods of treatment for such fracture.
Objectives:To assess the short-term results of ipsilateral fracture neck and shaft femur treated by modified traditional ante-grade intra-medullary nailing.
Methods: Fourteen patients with ipsilateral concomitant fracture neck and shaft femur treated by modified traditional ante-grade interlocking nailing. The surgery includes fixation of both neck and shaft fracture by interlocking nail (traditional type) and multiple long lag screws inserted via the nail itself toward the head and anterior or posterior to nail. Those patients followed for maximum 48 weeks to assess the risk of infection, knee stiffness, delayed union, mal-union, and non-union.
Results:One patient had superficial infection treated by oral antibiotics and improved (7.1%). Two patients had knee stiffness of mild degree (the range is 0-120) improved by physiotherapy (14.3%). Two patients had Trendelenburg’s gait (14.3%). One patient had non-union of femoral shaft (14.3%). One patient had mal-alignment of femoral neck (7.1%). One patient had mal-alignment of femoral shaft (7.1%). One patient had delayed union (failure to progress by 6 month as judged by serial radiographs) of femoral shaft (7.1%). Two patients need open reduction because of soft tissue interposed (14.3%). We lost follow up of 2 patients (14.3%).
Conclusion:Modified method for fixation of ipsilateral neck and shaft fracture with traditional interlocking nails and multiple long lag screws still can be adopted especially in the absence of cephalo-medullary nails with good results regarding early results. Still the cephalo-medullary nails may be better and required other studies.
Key words:Interlocking nailing, ipsilateral fracture neck and shaft femur.


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