cephalomedullary nail versus dynamic hip screw-plate fixation: a comparative analysis of ipsilateral femoral neck and shaft fracture outcomes

Background: simultaneous ipsilateral femoral neck and shaft fractures represent a complex orthopedic injury with ongoing debate over optimal fixation strategies. objectives: this study compares clinical outcomes between cephalomedullary nail (cmn) and dual-device fixations using a dynamic hip screw (dhs) for the neck and a plate for the shaft.methods: a retrospective review of 33 patients with concurrent femoral neck and shaft fractures was conducted. patients were treated with either a single cmn (n=18) or dual fixation with dhs and plate (n=15). outcomes analyzed included rates of fracture union, avascular necrosis (avn), and revision surgery. logistic regression assessed associations between patient factors (age, sex, smoking) and outcomes.results: the overall fracture union rate was 78.8%, while 21.2% experienced femoral shaft nonunion. avn developed in 24.2% of patients, and 45.5% required revision surgery. smokers had significantly higher rates of nonunion (41%), avn (47%), and revision surgery (88%) compared to non-smokers (0%; p<0.001). patients aged 50 or older had an increased risk of nonunion. in adjusted models, cmns were associated with higher—though not statistically significant—odds of nonunion compared to dhs and plate (aor: 4.77; 95% ci, 0.33%, 61.94%).conclusion: smoking and advanced age are strong predictors of adverse outcomes in patients with simultaneous femoral neck and shaft fractures. although both fixation methods yielded acceptable results, dual fixation with dhs and a plate may result in lower complication rates, particularly in high-risk groups. optimized patient selection and cessation of smoking may improve outcomes.