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Femoral Shaft Fragility Fractures: Peri-Implant Fracture Risk Mitigated by Femoral Neck Protection
William D Lack1, Micah Christenson2, Michael Murphy3
1Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Seattle, Washington, USA.
The Iowa Orthopaedic Journal
|July 23, 2026
Summary
Subsequent proximal femur fractures are a risk after femoral shaft fractures. Protecting the proximal femur during fixation significantly reduces this risk, highlighting its importance in patient care.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Geriatric Fracture Care
Background:
- Femoral shaft fragility fractures carry high morbidity and mortality.
- Limited data exists on subsequent fractures after femoral shaft fragility fractures.
- Key questions involve the incidence of proximal peri-implant femur fractures and the role of proximal femur protection during fixation.
Purpose of the Study:
- To determine the cumulative incidence of proximal peri-implant femur fractures after femoral shaft fragility fractures.
- To assess if proximal femur protection during fixation impacts the incidence of subsequent proximal peri-implant femur fractures.
Main Methods:
- Multi-center retrospective cohort study (2005-2024) at four level 1 trauma centers.
- Included patients aged 50+ with low-energy femoral shaft fractures requiring reduction and fixation.
- Fractures categorized by proximal femur protection; Kaplan-Meier survival analysis used.
Main Results:
- 245 patients (median age 75, 78.4% women) were analyzed.
- Subsequent proximal femur fracture rate was 0% with proximal femur protection vs. 4.8% without (p=0.030).
- Cumulative incidence reached 6.9% within 10 months without protection, versus 0% with protection (log-rank p=0.015).
Conclusions:
- Approximately 1 in 15 patients without proximal femur protection experienced a subsequent fracture within 10 months.
- Protecting the proximal femur during fixation significantly lowers the cumulative incidence of proximal peri-implant femur fractures.
- Prophylactic proximal femur protection should be considered in eligible patients to reduce re-fracture risk.
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