Clinical outcomes and prognostic factors of ipsilateral hip and femoral shaft fractures

The aim of this study was to analyze prognostic factors by investigation of the diagnostic process and clinical outcomes in patients with surgical management of ipsilateral hip and femoral shaft fractures.

Between August 1995 and January 2012, 26 cases who underwent fixation of ipsilateral fractures of hip and femoral shaft were reviewed. We evaluated patients' age, sex, location and type of the fracture, timing of diagnosis and surgery, method of fixation, combined injuries, time of bone union, and complications. Postoperative functions were assessed by Friedman and Wyman's criteria.

Femoral shaft fractures healed in 23 cases of 26 cases and in 3 cases of nonunion. Hip fractures healed in 25 cases of 26 cases, and in 1 case, there was nonunion. According to the outcome score followed by Friedman and Wyman's criteria, 13 cases had good results, 9 cases had fair results, and 4 cases had poor results. Timing of bone union and union rate were significantly different according to the degree of femoral shaft fracture comminution. Postoperative function was significantly different according to the degree of femoral shaft fracture comminution and the presence of ipsilateral fractures around the knee.

In cases of ipsilateral hip and femoral shaft fractures, more comminuted fractures of the femoral shaft and ipsilateral fractures around the knee, which resulted in delayed rehabilitation, caused poor postoperative functional outcomes. Because avascular necrosis and the presence of nonunion of femoral head are important in prognosis, delicate physical examination and radiologic evaluation of hip fractures are needed primarily before emphasizing anatomical reduction of hip fractures followed by rigid internal fixation.