Comparison of intramedullary nail and retrograde intramedullary nail combined with hollow lag screw fixation for treatment of ipsilateral femoral neck and shaft fractures

Objective To compare the effect of proximal femoral intramedullary nail fixation and femoral retrograde intramedullary nail combined with hollow lag screw fixation in the treatment of ipsilateral femoral neck and shaft fractures. Methods Data of 42 patients with ipsilateral femoral neck and shaft fractures who were admitted in our hospital from January 2007 to January 2016 were retrospectively analyzed. According to different fixation methods, the patients were divided into two groups: single intramedullary nail group (SIN group) (20 cases, treated with single proximal femoral intramedullary nail, 15 males and 5 females with an average age of 39.4); combined internal fixation group (CIF group) (22 cases, treated with femoral distal intramedullary nail combined with femoral neck hollow lag screw, 17 males and 5 females with an average age of 42.2 years). In the SIN group, 4 cases were type A, 9 cases type B, 7 cases type C according to AO classification. And 14 cases belonged to I or II (stable fracture), 6 cases of type III or IV (unstable fracture) according to Garden classification. In the CIF group, 3 cases were type A, 10 cases type B, 9 cases type C according to AO classification. And 16 cases belonged to type I or type II, 6 cases type III or IV according to Garden classification. The incision length, operation time, intraoperative blood loss, fracture healing time, postoperative weight time, stability of internal fixation, hip function score, pain in the knee and postoperative complication rate were compared between the two groups. Results There was no significant difference in gender, age and fracture classification between the two groups. The operation time (75.0±10.2 min), intraoperative blood loss (150.6±80.4 ml), hip Harris score excellent rate (80%) of incidence of knee pain in postoperative 3 months (10.0%) of the SIN group were significantly lower than those of the CIF group (105.2±18.4 min, 180.0±56.8 ml, 86.4% and 31.8%). The length of incision (8.3±1.4 cm) in the SIN group was significantly longer than that in the CIF group (4.0±0.6 cm). There was no significant difference in fracture healing time (SIN group 20.0±4.0 weeks, CIF group 19.6±4.2 weeks) and postoperative weight time (SIN group 8.2±4.0 weeks, CIF group 8.0±4.2 weeks) between the two groups. The main complications of the two groups were delayed union (3 cases of SIN group and 1 case of CIF group), nonunion of fracture (1 case of SIN group) and, coxa vara (1 case of SIN group). The complication of SIN group (30%) was significantly higher than that of CIF group (4.5%), which occurred mainly in unstable femoral neck fracture cases. Conclusion Both proximal femoral intramedullary nail fixation and femoral retrograde intramedullary nail combined with hollow lag screw can effectively treat femoral ipsilateral femoral neck and shaft fracture. Femoral retrograde intramedullary nail combined with hollow lga screw has more therapeutic advantages for unstable femoral neck fractures (Garden III and IV). Key words: Femoral fractures; Femoral neck fractures; Fracture fixation, intramedullary; Bone screws