Use Of Reconstruction Nail In The Treatment Of Bifocal Femoral FracturesA Prospective Case Series

The incidence of high velocity polytrauma leading to complex fractures is on rise. Bifocal femoral fracture include ipsilateral fracture of femoral diaphysis and either neck fracture or intertrochanteric fracture. These can be treated concomitantly by using single implant or two different implants to fix individual fractures. We present our results of treatment of these fractures using reconstruction nail.

We prospectively studied 50 consecutive cases with 38 males and 12 females who were in age group of 22 to 60 years (average age = 35.4 years), which were treated with reconstruction nails for ipsilateral fractures of neck and shaft femur during the period from June 2005 to June 2008. There were 22 femoral neck fractures, 28 femoral intertrochanteric fractures. Surgeries were done with minimal incisions and by the closed technique under Image intensifier. The results were evaluated based on the average union time for fractures, functional outcome based on criteria of Friedman and Wyman¹ and complications.

The mean follow up was 2 years; mean union time was 6 months. We had 82 percent Good 14 fair and 2 poor results. The poor results were cases of non union shaft femur that required plaint over the nail for fracture union. There were 4 delayed unions, and 3 malunion (2 coxa vara, 1 shaft malunion) and two cases of infections.

Reconstruction nailing in these fractures is a considerably less invasive procedure than conventional open fixation modalities. The use of reconstruction nail provides excellent mechanical stability with predictable results and low complication rates

Prospective case series