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Friday, March 2, 2001

CT scanning before fixation can prevent iatrogenic displacement

CT scanning before fixation of femoral shaft fractures can prevent iatrogenic displacement of occult femoral neck fractures, allowing appropriate treatment, say coauthors of poster exhibit 104.

To evaluate the incidence of ipsilateral femoral neck fractures associated with femoral shaft fractures and to determine the effectiveness of CT scanning in identifying these injuries preoperatively, they reviewed the preoperative pelvic and abdominal CT scans of 295 patients with 305 high-energy femoral shaft fractures. Over 18 months, 23 ipsilateral femoral neck fractures (22 patients) were identified, for an incidence of 7.5 percent. Six fractures were open. Fifteen of 23 fractures were nondisplaced or not visible on initial pelvic radiographs; 10 of these were identified on preoperative pelvic CT scans set to bone windows. CT could not be done in one patient because of morbid obesity. Two fractures were determined to be iatrogenic. The remaining fractures were identified during postoperative follow-up as displaced fractures.

Reconstruction IM nails were used in 13 fractures, retrograde IM nails with cannulated screw fixation in six, and antegrade IM nails with screw stabilization of the neck fracture around the nail in four.

"Ipsilateral femoral neck fractures occur in 1 percent to 6 percent of patients with high-energy femoral shaft fractures; 20 percent to 50 percent are missed initially," the coauthors say. "When such fractures are identified during or after fixation of the femoral shaft fracture, it is difficult to determine if the femoral neck fracture was present before surgery or occurred during the procedure. Careful review of a preoperative CT scan before fixation of the femoral shaft fracture can prevent iatrogenic displacement of a femoral neck fracture and allows early, appropriate treatment.

Coauthors of the study are D. Clint Morris, MD, Memphis, Tenn.; A. Paige Whittle, MD, Memphis, Tenn.; and Noel Henley, Memphis Tenn.

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2001 Academy News March 2 Index B

Last modified 20/February/2001 by IS