Segmental fractures of the femoral neck and shaft present a treatment challenge. A diagnostic difficulty sometimes arises because the classical signs present in an isolated fractured neck of femur are masked by the associated femoral shaft fracture. Especially where there is no preoperative pelvic radiograph, the femoral neck fracture may present as an incidental finding at the time the shaft fracture is treated. Because much of the impact at the time of injury is taken up by the femoral shaft, the fracture of the femoral neck is often undisplaced.

Between January 1995 and April 2001, we treated 36 patients with ipsilateral femoral neck and shaft fractures at GaRankuwa Hospital. Within 24 to 48 hours of injury, eight patients were treated with AO screws and DCP, two with DHS and DCP, 13 with Recon nails and 13 with UFN and Miss-a-nail. In four months 28 patients went on to uneventful union. Complications included two cases of implant failure, two of avascular necrosis, two of failed reduction of femoral neck fracture, one of sepsis and one of nonunion of the femoral shaft. The complications, especially implant failure and failed reduction, occurred mainly in patients who were operated on at night and by junior members of staff.