Abstract
Abstract
Introduction
Fractures of the proximal femur accompanied by a fracture of the femoral shaft are relatively rare, with a reported prevalence between 1 and 12%. Multiple surgical options are available, consisting of treatment with a single implant or with double implants. Controversy exists about the optimal management. A systematic review and pooled analysis were performed to assess the most reliable treatment for bifocal femoral fractures of the femur.
Materials and methods
A literature search was conducted on July 15, 2022. Selected studies were screened on title and abstract by two researchers independently, and full texts were read by both authors. Emphasis was put on adverse events such as postoperative infection, healing complications, malalignment, and functional outcome using either a single implant or double implants.
Results
For the proximal femoral fractures, no significant difference could be confirmed for avascular necrosis of the femoral neck (5.1% for single implant and 3.8% for double implants), nonunion (6.4% for single implant and 7.8% for double implants), or varus malalignment (6.6% for single implant and 10.9% for double implants). This study also suggests that the number of implants is irrelevant for complications of the femoral shaft regarding the rates of postoperative infection and healing complications. Pooled rates of bone healing complications were 1.6–2.7-fold higher when patients were treated with a single implant, but statistical significance could not be confirmed. For hardware failure, revision surgery, leg length discrepancy, and functional outcome, no difference between the two groups was found either.
Conclusions
The pooled proportions of all postoperative complications had overlapping confidence intervals; thus, no inference about a statistically significant difference on the number of implants used for treating ipsilateral fractures of the femur can be made. Both treatment groups showed a similar functional outcome at the last moment of follow-up, with more than 75% of the patients reporting a good outcome.
Publisher
Springer Science and Business Media LLC
Subject
Orthopedics and Sports Medicine,General Medicine,Surgery,Surgery
Reference88 articles.
1. Delaney WM, Street DM (1953) Fracture of femoral shaft with fracture of neck of same femur; treatment with medullary nail for shaft and Knowles pins for neck. J Int Coll Surg 19(3):303–312
2. Becher H (1951) [Nailing of femur neck fracture nailing of femur neck fracture with a concomitant fracture of femur head] Nagelung der Schenkelhalsfraktur bei gleichzeitig bestehender Oberschenkelfraktur. Zentralbl Chir 76(23):1609–1612
3. Okcu G, Aktuglu K (2003) Antegrade nailing of femoral shaft fractures combined with neck or distal femur fractures. A retrospective review of 25 cases, with a follow-up of 36–150 months. Arch Orthop Trauma Surg 123(10):544–550
4. Jain P, Maini L, Mishra P, Upadhyay A, Agarwal A (2004) Cephalomedullary interlocked nail for ipsilateral hip and femoral shaft fractures. Injury 35(10):1031–1038
5. Abalo A, Dossim A, Ouro Bangna AF, Tomta K, Assiobo A, Walla A (2008) Dynamic hip screw and compression plate fixation of ipsilateral femoral neck and shaft fractures. J Orthop Surg (Hong Kong) 16(1):35–38