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Arch Hellen Med, 19(3), May-June 2002, 270-279


Combined fractures of the femur

Orthopedic Clinic, University of Patras, Patras, Greece

The combination of fractures of the femoral shaft with fractures of the proximal and/or distal part are quite rare injuries, which may be missed at the primary examination in 20–31% of cases. These injuries usually occur in young people, injured in traffic accidents or falls from considerable height. Associated injuries are observed in 35–60% of cases. Classification systems and various surgical techniques have been proposed from time to time, but no specific conclusion has ever emerged. Most common complications concern the hip fracture and the knee injuries, however, the most important complications are those of osteonecrosis of the femoral head and pseudarthrosis of the femoral neck fracture. The incidence of osteonecrosis of the hip fracture is not known, but it is estimated to be between 4% and 22%. Pseudarthrosis of the hip fracture seems to be related mainly to the anatomic reduction and to the stable fixation, rather than to the amount of time passed. Knee joint complications are related to the extent of articular surface involvement, to the ligamentous damage, and to the quality reduction and stabilization. Although various treatment alternatives have been proposed, depending on the surgeon’s experience, the treatment goal should be achievement of anatomic and stable fixation of the fractures, in order to mobilize the patient. Intramedullary nailing and free cancellous screws, or the long gamma nail can safely be used to treat all combinations, and are the author’s method of choice.

Key words: Classification, Femur, Intramedullary nailing, Ipsilateral fractures.

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