Kemal AKTUGLU, Hakki ONCAG, Guray ALIN


Fracture of proximal femur associated with diaphyseal fracture requires osteosynthesis of both fractures which enables immediatejoint mobilization. Anatomical reduction of neck and.diaphyseal fracture are essential condition for consolidation. We reviewed the cases of' six patients who were treated at Ege University Hospital from January 1989 through December 1993. The average age was 33 (min. 26, max. 47) years. All of the patients were involved in a high-velocity accident. 5 (83%) patients had multiple trauma, 3 (66%) patients had an associated knee injury. (One ligamentous injury, one patella fracture and two tibial plateau fracture). Our protocol for this double fractures is treatment with immediate internal fixation; the femoral shaft fracture is given first priority and is reduced and immobilized with closed intramedullaiy naling, and then the femoral neck fracture is then treated with parallel cancellous screws. The hip and femur can be fixed internally through a single approach in a single position. The average follow-up was 26 (min. 6, max. 40) months. During an average follow-up of six months, all fractures healed. Decreased operative time, less blood loss, less technical difficulty, and early mobilization are important factors in the multiple-injured patient. Compared with other reports, our cases seems to have same functional results. The hip fracture was initially overlooked in 2 cases (33%). Overall, the prognosis with regarded 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. We concluded that ipsilateral neck and shaft fractures of the femur can be adequately stabilized with closed interlocking nailing and screw fixation.