What is the treatment approach for a patient with a femoral shaft fracture and a non-displaced femoral neck fracture?

From the Guidelines

The treatment approach for a patient with a femoral shaft fracture and a non-displaced femoral neck fracture typically involves surgical fixation of both fractures during the same procedure, with the most recent and highest quality study recommending this approach to reduce morbidity and mortality 1. The recommended strategy is to first stabilize the femoral neck fracture with multiple cannulated screws placed in a parallel configuration, followed by antegrade intramedullary nailing of the femoral shaft fracture. This approach addresses both injuries while minimizing the risk of displacing the femoral neck fracture during shaft fixation. Some key points to consider in the treatment approach include:

• Timing is crucial, with surgery ideally performed within 24-48 hours of injury to reduce complications, as recommended by recent studies 1.
• Preoperatively, the patient should receive appropriate pain management, DVT prophylaxis, and skeletal traction to maintain alignment until surgery.
• Postoperatively, patients typically begin protected weight-bearing for 6-12 weeks, with gradual progression based on radiographic evidence of healing. The combined approach is preferred because treating only the shaft fracture could lead to displacement of the neck fracture, while addressing both injuries simultaneously reduces the risk of avascular necrosis, nonunion, and the need for additional surgeries. Recent studies have emphasized the importance of early surgical stabilization of long bone fractures to facilitate patient mobilization, limit secondary displacement of fractures, and initiate early healing process 1. However, the delay in surgical management also depends on the associated lesions, whose management takes precedence over long bones fractures 1. It is essential to consider the patient's overall clinical status, physiological stability, and injury assessment when determining the optimal treatment approach 1.

From the Research

Mechanism of Femoral Shaft Fracture with Non-Displaced Femoral Neck Fracture

• The exact mechanism of a person having a femoral shaft fracture also ending up with a non-displaced femoral neck fracture is not explicitly stated in the provided studies.
• However, it can be inferred that high-energy trauma, which is a common cause of femoral shaft fractures, may also contribute to the occurrence of femoral neck fractures 2.

Treatment Approach for Femoral Shaft Fracture with Non-Displaced Femoral Neck Fracture

• The treatment approach for a patient with a femoral shaft fracture and a non-displaced femoral neck fracture involves immediate internal fixation, with the femoral neck fracture given first priority 3.
• The femoral neck fracture is reduced and immobilized with multiple cancellous screws, and the femoral shaft fracture is then treated with retrograde closed intramedullary Küntscher nailing 3.
• Alternatively, antegrade reamed intramedullary nailing with supplemental screw fixation of the femoral neck can be used 4.
• The choice of treatment approach depends on various factors, including the patient's condition, associated injuries, and the surgeon's preference 5, 3, 4.

Considerations for Treatment

• It is essential to consider the timing of femoral intramedullary nailing, the use of reaming, and the patient's associated comorbidities and body habitus when determining the treatment approach 5.
• The treatment protocol may need to be modified based on the individual patient's needs and circumstances 3.
• Closed reduction of femoral shaft fractures during intramedullary nailing can be aided by percutaneous skeletal joysticks 6.