From fracture to function: surgical management of trifocal femur fractures: a case series

Abstract

Trifocal femur fractures, characterized by fractures occurring at three distinct levels of the femur, are exceptionally rare injuries that usually result from high-energy trauma. Their management is challenging due to limited published evidence, complex fracture patterns, and the technical difficulty of achieving stable fixation across multiple segments. We present a case series of four patients with ipsilateral multilevel femur fractures, including trifocal injury patterns. Case 1 sustained a subtrochanteric fracture associated with a segmental shaft fracture; case 2 had an intertrochanteric fracture with a segmental shaft fracture; case 3 presented with intertrochanteric, shaft, and distal intra-articular femur fractures; and case 4 sustained fractures of the femoral neck, shaft, and distal femur. All patients underwent surgical management using individualized fixation strategies, including long proximal femoral nailing, cancellous screw fixation, bone grafting, and distal femoral plating as required. Radiological union was achieved in all fracture components except for incomplete union of the distal femur in one patient at two-year follow-up. Functional outcomes were satisfactory in all patients, with restoration of limb alignment, implant stability, and ambulatory function. Early recognition, meticulous preoperative planning, and stable fixation using appropriate load-sharing constructs are essential for achieving favorable outcomes in these complex injuries.