Segmental Fractures of the Neck of Femur: Fix or Replace?

Combined intracapsular and extracapsular fractures of the proximal femur—segmental fractures of neck of femur (SFNOF)—are rare and complex injuries. Literature regarding SFNOF is very limited; only one small retrospective study and 19 unique case reports have been described. We report the case of a 42-year-old man who suffered a compound subcapital femur fracture type Garden IV and an ipsilateral multifragmentary greater trochanter fracture from severe crush trauma. Neither the precise fracture constellation nor our management strategy, primary cemented total hip arthroplasty combined with tension band cerclage and triple K-wire trochanteric fixation, has been described in contemporary literature. We conclude that SFNOF needs clear categorization and derivative treatment principles. Prosthesis longevity, risk of nonunion, and avascular necrosis should be considered.