Abstract
Background. Ipsilateral hip and femoral shaft fractures are rare injuries and difficult to manage. Ipsilateral intertrochanteric and femoral shaft fractures occupy one fourth approximately of these injuries. Predominantly, male patients in the fourth decade of their life are suffering these fractures following polytraumatization. A high energy trauma known as the mechanism of these injury, in contrast to low energy trauma or pathological fractures.

Method. We present a case of 37 years old male with an additional ipsilateral trochanteric fracture on previously femoral shaft fracture. The patient suffered an open fracture of right femoral shaft with oblique configuration and displacement of the fracture segment. Patient and family refused to go for surgery. Ten months after the initial injury, patient had a motor vehicle accident for the second time and later was brought immediately to our center. Patient underwent plate and screw fixation for the femoral shaft fracture. The surgery worked well and postoperative the patient routinely attend the rehabilitation center.

Results. PFNA-long can stabilize and fix both fractures simultaneously compared with plate combinations. Operating time was shorter and perioperative blood loss less in the PFNA-long group

Conclusion. In ipsilateral intertrochanteric and femoral shaft fracture, a combination between proximal femoral nail anti-rotation and conservative plate and screw is an option to consider. The benefit from this option include shorter operation time and less intraoperative blood loss.

Key words: trochanteric fracture, atypical fracture, proximal femoral nail anti-rotation