J Korean Orthop Assoc.  2007 Jun;42(3):380-385. 10.4055/jkoa.2007.42.3.380.

Retrograde Intramedullary Nailing for the Treatment of Ipsilateral Femoral Shaft and Neck Fracture

• Oh CW
• Oh JK
• Kim SY
• Cha KB
• Jeon IH
• Park BC
• Min WK
• Kim TG

• KMID: 2186564
• DOI: http://doi.org/10.4055/jkoa.2007.42.3.380

Abstract

PURPOSE: To evaluate the results of the operative method for ipsilateral femoral shaft and neck fractures using retrograde nailing technique.
MATERIALS AND METHODS
Seventeen fractures (sixteen patients), followed-up more than 1 year, were included in this study. There were 14 men and 2 women, and the mean age was 44 years-old. According to the Winquist-Hansen classification, type II was most common with 11 cases. In femoral neck fractures, type B was most common with 13 cases according to AO-OTA classification and 6 of them were type II in Garden stage. After retrograde nailing of femoral shaft fractures, neck fractures were fixed by cannulated screw or dynamic hip screw.
RESULTS
The average time for union of shaft fractures was 27.3 (14-60) weeks. Nonunion occurred in five patients, who required bone grafts or changes of fixation. The average time for union of neck fractures was 11 (8-12) weeks. All united, except for one case of nonunion with avascuar necrosis, which was a Garden stage IV fracture. Functional results using Friedman-Wyman criteria were good in 16 cases, and fair in one. The only fair result was nonunion of the femoral neck, which had the joint arthroplasty.
CONCLUSION
Although the union rate of femoral shaft must be improved, retrograde nailing can provide an easy fixation and a favorable result for ipsilateral femoral neck fractures.

Keyword

Femoral shaft fractures; Femoral neck fractures; Retrograde nailing

MeSH Terms

Adult
Arthroplasty
Classification
Female
Femoral Neck Fractures
Femur Neck
Fracture Fixation, Intramedullary*
Hip
Humans
Joints
Male
Neck*
Necrosis
Transplants

Figure

• 

  Fig. 1 A 25-year-man suffered bilateral femoral fractures (A). Although the fracture of femoral neck was not evident on plain radiograph (B). Axial CT images showed it (arrows, C). Retrograde femoral nailing without reaming was done on the both femurs (D). After nailing, a vertical fracture line was seen on the right femoral neck (E). Then, three screws were fixed (F). At 4 month after operation, all fractures healed uneventfully (G & H).

• 

  Fig. 2 A 60-year-old man had a femoral shaft fracture and a severely displaced femoral neck fracture on the right leg (A). Retrograde nailing was done on the shaft fracture, and closed reduction was done on the neck fracture with three screws (B). At 3 month after operation, the screws of femoral neck drew back with nonunion of femoral shaft and neck (C). Arthroplasty and plate fixation were done (D).

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