Ipsilateral proximal and shaft femoral fractures: spectrum of injury involving the femoral neck.

Medical records and radiographs of 52 patients were studied after inclusion/exclusion criteria were met. The anatomical location of proximal femoral fractures that involved the femoral neck were examined after the primary fracture planes were drawn onto templates of the proximal femur. The AO classification is comprehensive and widely accepted. It has not been used in this injury combination in a large series of patients. Therefore, we classified each fracture by the AO method and then the AO classes were tabulated and analysed. Only three patterns of proximal femoral fractures appeared. The inferior aspect of the fracture line clustered in the inferomedial aspect of the femoral neck above an intact lesser trochanter in each separate pattern: 55 per cent were AO B2.1 (basilar); 35 per cent AO B2.3 (intracapsular); and 10 per cent AO A1.2 (pertrochanteric) fractures). Eleven fractures (21 per cent) were not detected initially. None of these were A1.2, eight were B2.1 and three were B2.3. Despite many proximal femoral fracture types reported in the literature only three fracture patterns were noted in this large study group. A new finding of clustering of these fractures in the inferomedial femoral neck was noted. AO class B2.1 fractures were the most common fractures missed at initial presentation and were the most common type seen.