Management of fracture shaft femur with ipsilateral un-united neck femur fracture with femoral neck system in situ, with review of fixation options

Ipsilateral fractures of the femoral neck and shaft are rare but complex injuries that require meticulous planning and surgical execution. The presence of a previously fixed but ununited femoral neck fracture using a novel implant, such as the femoral neck system (FNS), further complicates management. We present the case of a 23-year-old male who sustained a mid-shaft femur fracture following a road traffic accident. Notably, the patient had undergone surgical fixation of an ipsilateral femoral neck fracture two months prior using FNS. Radiographs revealed non-union of the femoral neck with early signs of avascular necrosis, along with a fresh shaft fracture. Surgical management included removal of the FNS and closed reduction with internal fixation using a cephalomedullary (sirus) nail. Proximal femoral fixation was augmented using two locking screws through the nail and one additional screw outside the nail. The patient had an uneventful postoperative recovery. At four-month follow-up, radiographs showed progressive union of both femoral neck and shaft fractures, with no radiographic signs of implant failure or further head collapse. This case illustrates the surgical challenges in managing sequential ipsilateral femoral fractures with prior implant in situ. Timely revision of the FNS and stabilization with a cephalomedullary nail allowed for successful outcome. Such complex cases require individualized surgical planning, and the combination of appropriate fixation techniques can yield satisfactory healing and functional recovery.