Cephalomedullary interlocked nail for ipsilateral hip and femoral shaft fractures Pankaj Jain*, Lalit Maini, Puneet Mishra, Ashish Upadhyay, Ajay Agarwal Department of Orthopaedics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi 110002, India Accepted 17 September 2003 Introduction Ipsilateral fractures of the femoral neck and shaft are rare and are usually encountered in high-energy injuries. 5,6,22 This is a combination of injuries that present diagnostic difficulties and complex treat- ment choices. Since reported initially, treatment of Injury, Int. J. Care Injured (2004) 35, 1031—1038 KEYWORDS Cephalomedullary nail; Ipsilateral hip; Femoral shaft fractures Summary A retrospective study of the management of 23 cases of ipsilateral hip and femoral shaft fractures, between January 1998 and December 2001, is presented. All except two cases were managed by a single implant, i.e. reconstruction nail. There was delayed diagnosis of femoral neck fracture in two cases where the ‘‘miss a nail’’ technique was used for fixation of the femoral neck fracture. All patients managed by reconstruction nail were simultaneously operated on for both fractures and operative treatment was executed as early as the general condition of the patient permitted. Delay in treatment was generally because of the associated injuries (head, chest or abdominal). There were 22 males and 1 female patient with an average age of 34.5 years. Average follow-up was 30.9 months. There was one case of non-union of the femoral neck fracture, one case of avascular necrosis and one femoral neck fracture united in varus. There were four cases of non-union and six cases of delayed union of femoral shaft fractures. Mean time for union of the femoral neck fracture was 15 weeks and for the shaft fracture was 22 weeks. In this series femoral shaft fracture determined the total union period. Complications involving the femoral shaft frac- ture were more common than those related to femoral neck fractures. Shaft complications were more manageable with or without secondary procedures as compared to femoral neck complications, which usually require more extensive procedures. This stresses the need to realise the significance and seriousness of both components of this complex injury, in evaluation, management and post-operative care. We conclude that, though technically demanding, reconstruction nail is an accep- table alternative for management of concomitant fractures of the femoral neck and shaft with acceptable rates of complications and good results. ß 2003 Elsevier Ltd. All rights reserved. *Corresponding author. Present address: H-272, R.K. Apartments, I.P. Extension, Delhi 110092, India. Tel.: þ91-11-22516481. E-mail address: drjainpan@hotmail.com (P. Jain). 0020–1383/$ — see front matter ß 2003 Elsevier Ltd. All rights reserved. doi:10.1016/j.injury.2003.09.039