Ipsilateral hip and femoral shaft fractures

Forty-two cases of ipsilateral hip and femoral shaft fractures are reviewed. All patients were treated operatively for both fractures, with the exception of the shaft fracture in one child. Several different methods of fixation were used. The most common method was placement of multiple pins or screws around a previously placed intramedullary rod. Initial rodding of the shaft was not associated with avascular necrosis of the femoral head. Nonunion of the femoral neck occurred in three patients as a result of initial displacement and subsequent malreduction. Delays in operative fixation up to six weeks did not affect the ability to obtain union of the femoral neck. Complications involving the shaft fracture were at least as common as complications involving the femoral neck, suggesting that this component of the double injury should receive equally serious consideration. The hip fracture was initially overlooked in 13 cases (31%) without subsequent nonunion or avascular necrosis. Overall, the prognosis with regard to healing of the femoral neck and avascular necrosis of the femoral head in these combination injuries was found to be superior to that of isolated femoral neck fractures in young adults.