[Reconstruction intramedullary nailing for the treatment of ipsilateral fractures of shaft of femur and hip].

OBJECTIVE: To evaluate the curative effect and surgical skills of reconstruction intramedullary nailing for ipsilateral fractures of shaft of femur and hip. METHODS: Fifteen patients with ipsilateral femoral shaft and hip fractures from June 2002 to June 2008 were treated with reconstruction intramedullary nails. All of them were male with an average age of 45 years (range,34-85 years). According to the Winquist-Hansen classification, there were 2 type I, 6 type II, 2 type III, and 2 type IV shaft fractures. Hip fractures consisted of 7 intertrochanteric and 8 (53.3%) neck fractures. According to Garden's classification, 1 femoral neck fracture was type I, 3 were type II, 2 were type III and 2 were type IV. RESULTS: All of the patients were followed up for an average of 30.9 months (range, 12 to 55 months). Due to other combined severe injuries, operations were delayed for 1-14 days (average is 5 days). Delayed union of femoral shaft occurred in 1 case; nonunion of femoral shaft occurred in 2 cases. Nonunion of femoral neck occurred in 1 and coxa vara occurred in 1. Hip fractures healed in 14 (93.3%) patients, and shaft fractures healed in 13 (86.7%)patients. The average union time was 4 months (range, 2-6 months) for the hip fractures and 5.5 months (range, 4-9 months) for the shaft fractures. No femoral head osteonecrosis, wound infection or shortening more than 2 cm occurred. Functional results using Friedman-Wyman criteria were good in 13 cases, fair in 1 case, and poor in 1 case. CONCLUSION: Reconstruction intramedullary nails can provide biological fixation of both fractures with fewer complications, and is an effective device to treat this kind of combined fractures.

Treating gunshot femoral shaft fractures with immediate reamed intramedullary nailing.

Reamed intramedullary nailing was used within 36 hours of patient admission to treat 32 consecutive femoral shaft fractures caused by low-velocity gunshot wounds. The femoral shaft fracture was classified according to the AO system, and comminution was graded according to the classification of Winquest and Hansen. Patients were followed for an average of 14.7 months (range, 6 to 36 months), and the average time to union was 18.6 weeks. The average hospital stay was 7 days, which is approximately one half the average stay reported in the literature for treating this kind of injury with delayed nailing. The shorter hospital stay represents potential savings of up to $9,000 per patient. Immediate intramedullary rodding is a safe, effective, and economic option for the treatment of a femoral shaft fracture caused by a low-velocity gunshot wound. However, a lack of compliance with instructions concerning weight-bearing in this patient population needs to be taken into account when planning postoperative care.