Surgical treatment of XXXX .

@entity1 @entity174 @entity572 @entity881 @entity3330 @entity130
UNASSIGNED: BackgroundConcurrent ipsilateral @entity174 of the proximal and shaft of the femur are rare complex @entity174 combinations. In this prospective cohort study, we evaluated clinical and radiological long-term results after operative treatment using several surgical strategies: the so-called   rendezvous   surgical technique, e.g., the combination of retrograde intramedullary nailing and @entity572 ( @entity572 ) osteosynthesis, or the all-in-one device technique, e.g., long cephalomedullary nail, compared with two non-overlapping implants (e.g., conventional technique).MethodsIn a 10-year-period from 2004 to 2013, we treated 65 @entity1 with @entity3330 . Median age was 45  years (range 19  90 years). @entity174 were classified according to the AO/OTA classification. Four @entity1 died during intensive care unit treatment due to @entity881 prior to definitive osteosynthesis. Clinical long-term outcome using the functional system of Friedman/Wyman as well as radiological outcome was evaluated 2  years after @entity130 (range 13  42 months).ResultsAll-in-one device was used in 36 @entity1 ,   rendezvous   technique in 9 @entity1 , and the conventional technique in the remaining 16 @entity1 . Two years after @entity130 , complete @entity174 healing was found in 57 out of 61 @entity1 (  rendezvous  : 9, all-in-one device: 33, conventional: 15; p-value: 0.66). There was no significant difference regarding the complication rate in the cohort groups (  rendezvous  : 3, all-in-one device: 13, conventional: 5; p-value: 0.94). Using the functional assessment system of Friedman/Wyman 2  years after @entity130 , a good clinical result was found in 77.7% in the   rendezvous   group, in 77.8% in the all-in-one device group, and in 75% in the conventional group.ConclusionThe indication for operative stabilization of @entity3330 is considered an urgent and emergency procedure. Based on the successful long-term results of this study, we prefer the   rendezvous   technique with @entity174 stabilization from distally to proximally. Both @entity174 components require stable fixation. It is advisable to stabilize the shaft @entity174 primarily using external fixation (damage control orthopedics) and the @entity3330 using early definitive internal fixation. In a second and staged operation, the external fixator is removed and the shaft @entity174 is stabilized using retrograde nail osteosynthesis with overlapping of the @entity572 and nail implants.
