Double Trouble of "Double Segmental" Fractures - A Report of Two Cases

A "double segmental" fracture is an injury pattern that has three fracture sites and four fracture segments in a single bone. It is extremely rare, with only three "Double segmental femoral fracture" and only four "double segmental tibia fracture" cases reported in the literature. These fractures are associated with difficulty in deciding the implant for fixation, segment reduction, maintenance of reduction, maintaining blood supply of segment during fixation, and the high risk of post-operative complications.

We present two unique cases, one of "double segmental femur fracture" and the other of "double segmental tibia fracture," fixed with intramedullary nailing. When Schanz screw or Steinman pins were used to reduce the intermediate fragments and hold them in place, they interfered with the reaming due to the protruding part in the narrow canal. This problem could be solved using weber clamps to hold reduction as they do not obscure the canal. All the fractures united uneventfully at 9 months follow-up.

A "single intramedullary device" to fix "all the segments" can help provide stabilization without compromising soft-tissue attachments and viability of the intermediate fracture segments in "double segmental" fractures.