The management of segmental femur fractures: the radiographic 'cover-up' test to guide decision making

• Published in: Injury 2022-08, Vol.53 (8), p.2865-2871
• Main Authors: Ferreira, Nando, Britz, Elsabe, Gould, Alan, Harrison, William D
• Format: Article
• Language: English
• Subjects: Femur fracture; Internal fixation; Radiographic cover-up test; Segmental fracture
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2022.05.050

•Significant variation is seen in the fracture location of segmental femur fractures, especially with regards to the proximal fracture.•Good outcomes in terms of alignment and union can be expected in segmental femur fractures.•A simple radiographic cover-up test can guide the choice of fixation and result in the gold standard of fixation being used for most fractures. Segmental femur fractures often pose management challenges regarding the optimal fixation choice and sequence of surgical events. Retrospective review of clinical records and radiographic data of adult patients with segmental femur fractures treated by a conceptual radiographic cover-up test to determine the ideal fixation method between January 2019 and December 2020. Forty patients with 84 individual fractures underwent fracture fixation. The most consistent fracture combinations were intertrochanter-diaphysis (AO31A-AO32) fractures (25%, n = 10) and femur neck-diaphysis (AO31B-AO32) fractures (20%, n = 8). Compared to evidence-based fracture management, the gold standard treatment was used for the fixation of 78 fractures (93%). One patient required revision for fixation failure of a diaphyseal fracture, and two fractures, both open diaphysis injuries, developed fracture-related infections. Anatomical alignment and high union rates are possible for segmental femur fractures treated by evidence-based fracture fixation principles. A conceptual radiographic cover-up test assists in matching the best possible implant for each fracture.