Authors : Juvin Joseph, Abhishek Samuel
DOI : 10.61336/im/26-06-222
Volume : 8
Issue : 6
Year : 2026
Page No : 1486-1495
Background: The concomitant occurrence of a ipsilateral diaphyseal femoral shaft fracture and an ankle fracture is uncommon, and the incidence of this combined injury pattern has not been clearly defined in literature. The aims of this case series were to describe the clinical presentation, radiological characteristics, surgical management, and outcomes of patients with concomitant diaphyseal femoral shaft and ankle fractures; to highlight practical considerations regarding fixation sequence and implant selection; and to provide a focused review of relevant literature. Methods: A narrative review was conducted using selected peer-reviewed articles focusing on femur fracture and related ipsilateral lower limb injuries, including epidemiological studies, case reports. Results: Skeletal injury patterns consisted of diaphyseal femur fractures (AO/OTA 32) paired with malleolar ankle fractures (AO/OTA 44). Surgical stabilization was standardized across the cohort, utilizing intramedullary interlocking (IMIL) nailing for all femur fractures and open reduction and internal fixation (ORIF) plating for all ankle fractures. Surgical staging varied; simultaneous single-sitting stabilization was achieved in 33.3% (n=1) of cases, while the remaining 66.7% (n=2) underwent staged ankle fixation at a median of 4 days post-injury (range: 2–6 days). The mean total time from injury to definitive surgical fixation was 27.3 ± 23.1 hours. The mean timeline to achieve full weight-bearing (FWB) status was 7.3 ± 2.3 weeks. Conclusion: This case series highlights the rare and challenging injury pattern of concomitant diaphyseal femoral shaft and ipsilateral ankle fractures. We propose a novel classification system that incorporates injury definition, soft-tissue modifiers, surgical sequencing, implant selection, and postoperative rehabilitation protocols for these complex segmental lower-limb injuries. This classification provides a practical framework for clinical decision-making and may facilitate standardized management and future research in this uncommon injury pattern