Maine Orthopaedic Review Challenge

Test Your Knowledge of Treating Fractures in Trauma Patients

Bruce F. Gomberg, MD; Brad J. Yoo, MD


August 24, 2017

An ipsilateral femoral neck fracture occurs in approximately 9% of all femoral diaphyseal fractures. The fracture is frequently vertical and nondisplaced, and it is associated with younger patients. CT of the abdomen and pelvis can be used preoperatively to investigate the presence of an ipsilateral femoral neck fracture.

Although there is no clear consensus regarding the optimal treatment of femoral shaft and neck fractures,[1] in this scenario, the femoral nail is already in place. The nondisplaced femoral neck fracture can be stabilized with implants placed around the previously placed femoral nail. Removal of the nail and placement of screws to secure the femoral neck is an option, but not necessary in this instance. Observation is not recommended in this scenario owing to concern about late femoral neck fracture displacement and risk for osteonecrosis.


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