Outcomes after Trifocal Femoral Fractures

Trifocal femur fractures are those of the femoral neck, diaphysis, and distal femur. These high-energy injuries predominantly occur in young people with the potential for long-term complications and disability. We present the cases of two men who were treated with proximal dynamic hip screws and distal periarticular locking plates to effectively manage trifocal femur fractures. Our cases have shown union at 2 years with good functional outcomes without the need for reintervention. We provide evidence for a successful surgical treatment option for these rare and complex injuries. 1. Introduction Isolated fractures of the diaphysis of the femur are relatively common injuries with an estimated annual incidence of 10 per 100,000 person-years [1]. Multifocal fractures of the femur are less common with an additional proximal femoral fracture estimated to occur in up to 5% of diaphyseal fractures [2] and additional distal femoral fracture occurring in 3-4% [3]. Trifocal femoral fractures consisting of ipsilateral fractures of the proximal, diaphyseal, and distal femur are extremely rare. Such an injury pattern was first reported by K？ch in 1993 [4] and to date the literature reports 18 cases of trifocal femur fractures [3–8]. These injuries result from high-energy mechanisms, usually a high-speed road traffic collision. Due to the rarity of such injuries and the heterogeneity of the fracture patterns there is minimal consensus on their optimal management. We present two cases of trifocal femur fractures managed with dynamic hip screws and distal periarticular locking plates, a technique which to the best of our knowledge has not previously been reported for the management of trifocal femur fractures. 2. Case Report 1 A previously fit and well 41-year-old male coach driver was involved in a high speed road traffic collision with a two-hour period of entrapment in his vehicle prior to extrication and transfer to our level 1 Trauma Centre. On arrival the patient was haemodynamically stable with no evidence of significant head injury. The patient was complaining of pain in the right thigh and had an obviously deformed right lower extremity. Radiographs revealed a grossly displaced diaphyseal femoral fracture with significant comminution and extension into the femoral condyles with a displaced ipsilateral basicervical femoral neck fracture (Figures 1(a) and 1(b)). The fractures were classified according to AO/ASIF classification as 31-B2, 32-B2, and 33-B2. The patient’s other injuries included a right radius and ulna fracture and a subcapsular splenic haematoma,