Case Report Outcomes after Trifocal Femoral Fractures Michelle Griffin, Alastair G. Dick, and Shamim Umarji Orthopaedic Department, St. George’s Hospital, London SW17 0QT, UK Correspondence should be addressed to Shamim Umarji; sumarji@hotmail.com Received 15 December 2013; Accepted 13 February 2014; Published 1 April 2014 Academic Editors: F.-M. Haecker and G. Rallis Copyright © 2014 Michelle Griin et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Trifocal femur fractures are those of the femoral neck, diaphysis, and distal femur. hese high-energy injuries predominantly occur in young people with the potential for long-term complications and disability. We present the cases of two men who were treated with proximal dynamic hip screws and distal periarticular locking plates to efectively manage trifocal femur fractures. Our cases have shown union at 2 years with good functional outcomes without the need for reintervention. We provide evidence for a successful surgical treatment option for these rare and complex injuries. 1. Introduction Isolated fractures of the diaphysis of the femur are relatively common injuries with an estimated annual incidence of 10 per 100,000 person-years [1]. Multifocal fractures of the femur are less common with an additional proximal femoral fracture estimated to occur in up to 5% of diaphyseal fractures [2] and additional distal femoral fracture occurring in 3- 4% [3]. Trifocal femoral fractures consisting of ipsilateral fractures of the proximal, diaphyseal, and distal femur are extremely rare. Such an injury pattern was irst reported by K¨ ach in 1993 [4] and to date the literature reports 18 cases of trifocal femur fractures [3–8]. hese injuries result from high-energy mechanisms, usually a high-speed road traic collision. Due to the rarity of such injuries and the heterogeneity of the fracture patterns there is minimal consensus on their optimal management. We present two cases of trifocal femur fractures managed with dynamic hip screws and distal periarticular locking plates, a technique which to the best of our knowledge has not previously been reported for the management of trifocal femur fractures. 2. Case Report 1 A previously it and well 41-year-old male coach driver was involved in a high speed road traic collision with a two-hour period of entrapment in his vehicle prior to extrication and transfer to our level 1 Trauma Centre. On arrival the patient was haemodynamically stable with no evidence of signiicant head injury. he patient was complaining of pain in the right thigh and had an obviously deformed right lower extremity. Radiographs revealed a grossly displaced diaphyseal femoral fracture with signiicant comminution and exten- sion into the femoral condyles with a displaced ipsilateral basicervical femoral neck fracture (Figures 1(a) and 1(b)). he fractures were classiied according to AO/ASIF classiication as 31-B2, 32-B2, and 33-B2. he patient’s other injuries included a right radius and ulna fracture and a subcapsular splenic haematoma, which was managed conservatively. Surgery was performed on the same day, shortly ater admission. Under general anaesthesia the patient was posi- tioned on a standard radiolucent traction table. First the proximal fracture was reduced and stabilised using a two- hole plate dynamic hip screw (DHS) with a derotation screw. An extended lateral approach was then used to reduce and stabilise the distal fractures with a 16-hole locking plate (AxSOS Distal Lateral Femoral Plate, Stryker, Mahwah, NJ, USA) (Figures 1(c) and 1(d)). he upper limb injury was splinted but not deinitively stabilised at this time. he patient required an eight-day postoperative period in the intensive care unit. He developed acute renal failure secondary to rhabdomyolysis and required renal replacement therapy. He underwent an open reduction and internal ixa- tion of the forearm fractures ater ive days. he patient then had an uneventful postoperative course and was discharged from hospital 23 days postoperatively. Hindawi Publishing Corporation Case Reports in Surgery Volume 2014, Article ID 528061, 4 pages http://dx.doi.org/10.1155/2014/528061