Concomitant Ipsilateral Femoral Shaft and Ankle Fractures: A Case Series and Proposal of a Novel Classification System
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
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