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Ipsilateral Femoral Neck and Shaft Fractures: Complex Injuries With High Rates of Femoral Shaft Nonunion
Douglas R Haase1, Augustine M Saiz2, Jonathan G Eastman3
1Department of Orthopaedic Surgery, University of Missouri-Columbia, Columbia, MO.
Journal of Orthopaedic Trauma
|October 21, 2024
Summary
Ipsilateral femoral neck and shaft fractures have high nonunion rates. Perioperative blood transfusion and AO/OTA Type C fractures are independent risk factors for femoral shaft nonunion.
Area of Science:
- Orthopedic surgery
- Trauma surgery
- Bone healing
Background:
- Ipsilateral femoral neck and shaft fractures are complex injuries.
- Treatment of these combined fractures presents significant challenges.
- High nonunion rates for the femoral shaft component are a concern.
Purpose of the Study:
- To determine the nonunion rates in patients with ipsilateral femoral neck and shaft fractures.
- To identify risk factors associated with femoral shaft nonunion in this patient population.
Main Methods:
- Retrospective review of 154 patients with ipsilateral femoral neck (AO/OTA 31-B) and shaft (AO/OTA 32A-C) fractures.
- Data collected from two Level I trauma centers between 2013 and 2022.
- Analysis included evaluation of smoking, open fracture, delay to weight-bearing, blood transfusions, and fracture classification.
Main Results:
- A 22% rate of femoral shaft nonunion was observed.
- Independent risk factors for nonunion included perioperative blood transfusion (≥3 units) and AO/OTA Type C femoral shaft fractures.
- Other associated factors were open fractures and delayed weight-bearing.
Conclusions:
- Ipsilateral femoral neck and shaft fractures are challenging injuries with high rates of femoral shaft nonunion.
- Successful management requires careful attention to the femoral shaft component.
- Identifying and mitigating risk factors is crucial for improving outcomes.
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