Complex Bifocal Femoral Fractures

Complex combined injuries to the femora represent a small subset of femur injuries yet warrant the treating surgeon’s utmost attention. This chapter aims to heighten the orthopedic surgeon’s awareness of these combined patterns to improve operative outcomes and minimize complications. Intracapsular and extracapsular femur injuries combined with femoral shaft injuries occur in combination less than 10%, with the majority being intracapsular/shaft combination. Classically, surgeons in training are taught to look for these subtle injuries, but diagnosis is still missed frequently. Misdiagnosis/failure to recognize these patterns leads to higher complication rates noted versus univocal femur injuries. Systematically, this chapter aims to create a “surgical walk-through.” By highlighting preoperative planning/patient evaluation, creation of a “stable operative platform,” surgical approaches, and reduction techniques, both open and closed, the chapter provides a road map for successful treatment of patients with bifocal femoral injury. Ultimately, the authors provide their specific tips, tricks, and pitfalls to addressing these relatively unusual but difficult injuries to treat.