Role of Cephalomedullary Nailing in Ipsilateral Neck and Shaft Fractures of Femur

Ashok Sunil Gavaskar, K G (2007) Role of Cephalomedullary Nailing in Ipsilateral Neck and Shaft Fractures of Femur. Masters thesis, Madurai Medical College, Madurai.


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INTRODUCTION: Ipsilateral neck fractures occur in as many as 9% of all shaft fractures. This injury pattern was first described by Delaney & Street in 1953. In most instances, the neck fracture line is almost vertical and undisplaced or minimally displaced. The femoral neck fracture often is missed. Numerous treatment protocols have been recommended for the treatment of this combination injury pattern. Treatment options include: (1) Antegrade femoral nailing of the shaft with cancellous screws placed anterior to the nail for fixation of the neck, (2) Reconstruction-type intramedullary nailing using proximal interlocking screws that pass through the proximal nail segment, across the femoral neck fracture and into the femoral head (this technique has been described with and without the use of additional cancellous lag screws to augment the neck fixation, (3) various plate combinations (including a hip screw and long side plate configuration, a hip screw with short side plate for the neck and separate plate for the shaft, or cancellous screws for femoral neck and a plate for the shaft, and (4) retrograde intramedullary nailing for shaft fixation with cancellous lag screws placed superior to the tip of the nail for neck stabilization. AIM: The purpose of this study is to analyze the efficacy of cephalomedullary nailing in the treatment of ipsilateral fractures of neck and shaft of femur with special emphasis on technical difficulties and complications MATERIALS AND METHODS: 25 patients with ipsilateral neck and shaft fractures who underwent cephalomedullary nailing at our institution were included in our study. 22 were males and 3 were females. 17 fractures were on the right side and 8 on the left side. The age of the patients ranged from 17 – 64 years. The period of study was from June 2004 to June 2006. All patients were followed regularly and the average period of follow up was 16.2months (7 – 24 months). RESULTS: The operating time was calculated from the start of surgical incision to wound closure. The operating time gradually improved with our experience. It varied from 65 min to 135 min. The blood loss was calculated from the number of surgical mops used each corresponding to 50 ml. Blood loss in our series varied from 100 to 250 ml. The duration of image intensifier usage was calculated in seconds. It varied from 50 – 140 seconds. The results obtained and complications encountered were analysed with respect to certain parameters such as timing of surgery, fracture pattern (location, personality, and location), surgical experience, presence of associated injuries, method of reduction employed and the type of implant used. CONCLUSION: In conclusion, a locked intramedullary nail with two proximal screws in the femoral neck and one or two distal locking screws seem useful for extended indications in complex femoral fractures, wherein previous techniques have not yielded uniformly good results.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Cephalomedullary Nailing ; Ipsilateral Neck and Shaft Fractures ; Femur.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 15:12
Last Modified: 17 Sep 2017 02:31

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