Management and prevention of iatrogenic ipsilateral femoral neck fracture during intramedullary nailing of femoral shaft

Table 1 Etiological classification of iatrogenic femoral neck fractures (n = 18)

Etiology	Number of cases	Timing of diagnosis	Displacement status	Fixation method used
Erroneous entry point	6	Intraoperative	4 undisplaced, 2 displaced	Long PFN (5), CCS (1)
Inadvertent jig hammering	5	Intraoperative	3 undisplaced, 2 displaced	Long PFN (3), CCS (2)
Misdirected nail manipulation	3	Intraoperative	2 undisplaced, 1 displaced	Long PFN (2), CCS (1)
Hoop stress-related fracture	3	Postoperative (≤ 4 weeks)	1 undisplaced, 2 displaced	CCS (2), hemiarthroplasty (1)
Unexplained origin	1	Immediate postoperative	Displaced	CCS (1)

PFN: Proximal femoral nail; CCS: Cannulated cancellous screw.

Table 2 Association between timing of diagnosis and fixation strategy, n (%)

Timing of diagnosis	Number of cases	Common fixation method(s)	Mean surgical duration (minute)	Union achieved at 12 months
Intraoperative	14	Long PFN, CCS	110 ± 15	12/14 (85.7)
Immediate post-operation	1	CCS	125	1/1 (100)
Delayed post-operation (≤ 4 weeks)	3	CCS, hemiarthroplasty	145 ± 20	1/3 (33.3)

PFN: Proximal femoral nail; CCS: Cannulated cancellous screw.

Table 3 Outcome analysis based on fixation method

Fixation method	Number of cases	Displacement status	Union at 6 months	Union at 12 months	Complications observed
Long proximal femoral nail	10	6 undisplaced, 4 displaced	9/10	9/10	1 delayed union
Cannulated cancellous screws	6	4 undisplaced, 2 displaced	5/6	5/6	1 superficial infection
Hemiarthroplasty + plate	1	Displaced	NA	NA	No AVN, satisfactory function

NA: Not available; AVN: Avascular necrosis.

Table 4 Statistical correlation of surgical variables with outcome

Variable	P value	Interpretation
Timing of diagnosis vs union	> 0.05	Not statistically significant
Fixation method vs union	> 0.05	No significant difference in union rates
Surgical duration vs outcome	< 0.05	Longer duration is associated with poorer outcomes
Displacement status vs AVN	NA	No AVN observed during follow-up

NA: Not available; AVN: Avascular necrosis.