Clinical Analyze And Research Of Ipsilateral Femoral Neck And Shaft Fractures

Objective: With the diversification of people’ s living standards and life style, outdoor activities and the increase in th e prosperity of transportation as a result of the occurrence of fracture is more and more high, also increased year by year high energy production with femoral fractures, femoral shaft and ipsilateral femoral neck fract ure patients although rare, but because of its special the anatomical structure and physiological function of important, one of the fractures are easily miss ed, difficult to treat, the domestic and foreign medical predecessors put forward m any methods for t he treatment of this fracture, but there is no unified treat ment method, thi s paper analyzed retrospectively through the ipsilateral femoral neck fracture in our hospital femoral shaft with clinical data, charac teristics to investigate the cause of misdiagnosis of t he fractures and dif ferent treatment methods, in order to improve the doctor for this ki nd of fracture attention and fi nd out the best method of treatment.Method: From Jilin University in August 2013 to Decem ber 2015 China Japan Union Hospital of fem oral shaft fracture combined with ipsilateral fem oral neck fracture cases of patients with a total of 13 patients, a retrospective analysis of the clinical data of 13 cas es of the patients, one case were found in the occult fem oral neck fractures, patients with sur gical equipment selection, 8 cases with gamma-3 type in tramedullary needle also the fixation of femoral shaft and neck fractures; 4 cases of patients with fem oral neck adopts a hollow screw fixation, femoral shaft using retrograde intramedullary pin fixation; 1 case with dynamic hip screw fixation of femoral neck fracture and dynamic compression plate fixation of femoral shaft fracture. Through all of these cases in the cause o f injury, age, injury of soft tissue, wh ether combined with other injury, preoperative examination, fracture type, fracture fixation method and the operative tim e, bleeding quantity and volum e of blood transfusion, hospitalization time and postoperative the fracture healing time and other conditions are classified and analyzed, summarize all patients preoperative design and taken according to the operation situation of copi ng strategies and analysis in the treat ment of femoral shaft fractures with ipsilateral femoral neck fracture cause s of m issed diagnosis and ef fective treatment measures.Results: All the 13 patients were followed up for 6-28 months, average 13 months. 13 cases of patients were healed fractur e, femoral shaft fracture healing time was 3-6 months, with an average of 4.3 months, the femoral neck fracture healing time was 3-5 m onths, an average of 3.5 months, refer to "karlstrom and Olerud ipsilateral femoral and tibia l fracture curative ef fect evaluation standard" [7] and parkland and Palmer mobility score "[8] of hip joint and knee joint function evaluation method and the development of evaluation criteria, postoperative limb function was excelle nt in 1 cases, good in 1 1 cases, 1 cases, the excellent and good rate was 92.3%. No necrosis of the fem oral head wa s found in all the patients, and no complications such as internal fixa tion failure, joint infection and nerve injury were found. Due to the smaller sample size, not through the treatment of statistics to clear in which a fixed way more applicable in fem oral shaft with ipsilateral femoral neck fracture, also not clear in patients with gender, age, injury factors the and femoral sh aft nonunion and avascular necrosis of the femoral head has no direct correlation.Conclusion: The principle of imaging of patients with fem oral shaft fracture combined with ipsilateral femoral neck fracture of early misdiagnosis rate is high, so the prognosis is poor. In this regard, summed up the following points to prevent missed diagnosis: 1for femoral shaft fracture, should be asked in detail about the causes of injury, meticulous physical examination for high energy injury patients need attention,2strictly follow the "three two", which includes fracture near two joints, two range(positive and lateral) and two period(when injury and 2 weeks after); 3for high energy injury reasons or highly suspected femoral neck fracture patients need with CT or MRI to leak diagnosis; 4 To further im prove the physician of the fracture of the understanding and attention.Combined with our experience in th e treatment of, the author believes that early diagnosis and avoid additi onal damage and fracture displacement, anatomic reduction and strong inte rnal fixation and early, systematic functional exercise is key to obtai n the good treatment results, internal fixation material option is adm ittedly important, but need according to the individual patient and two fracture situ ation, into account, choose the m ost suitable for the patients with internal fixation material. Because this study is a retrospective analysis, there were fewer, for up to five years waiting for the lack of no clinical follow-up, Zo joined the election cases, randomized, double blind method, take the long-term follow-up, in order to find out the optimal diagnosis, treatment method.