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Yin Z, Yang S, Yu J, Chen S, Feng T, Huo Y, Yin J, Zhang Y. Analysis of the influence of circumference and displacement of the third fracture fragment on the healing of femoral shaft fractures treated with intramedullary nailing. Sci Rep 2024; 14:18173. [PMID: 39107419 PMCID: PMC11303383 DOI: 10.1038/s41598-024-69137-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 07/31/2024] [Indexed: 08/10/2024] Open
Abstract
The effect of circumference and displacement of the third fracture fragment on fracture healing after intramedullary nailing of femoral shaft fractures with a third fracture fragment was investigated. A retrospective cohort study was conducted to analyze the data of 142 patients who suffered femoral shaft fractures with a third fracture fragment and were admitted to the First People's Hospital of Lianyungang from February 2016 to December 2021. According to the circumference of the third fracture fragments, these were divided into three types of type 1: 71 cases; type 2: 52 cases; and type 3: 19 cases. On the basis of the diaphyseal diameter, the degree of displacement of the third fracture fragment was classified into three degrees of degree I: 95 cases; degree II: 31 cases; and degree III: 16 cases. Postoperative follow-up was performed to compare the fracture healing rate, healing time, and the modified Radiographic Union Scale for Tibia (mRUST) at 9th month after surgery in each group. All 142 patients were followed up after operation, with an average of (14.7 ± 4.1) months, and the overall healing rate was 73.4%. When the third fracture fragments were displaced in degree II and III, the mRUST score at 9th month in the type 1 group was higher than that in the type 2 and 3 groups (P = 0.017). Logistic regression analysis showed that greater displacement of third fracture fragments and greater circumference were associated with lower fracture healing rates (P < 0.05). After intramedullary nailing of femoral fractures, the degree of third fragment displacement and circumference affect fracture healing, and the former has a greater impact. When the third fracture fragment is displaced to degree II or III and its circumference is type 2 or type 3, it significantly affects the fracture healing. Intraoperative intervention to reduce the distance of third displacement of the fragment is required to reduce the incidence of non-union.
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Affiliation(s)
- Zhaoyang Yin
- Department of Orthopedic Surgery, Affiliated Lianyungang Hospital of Xuzhou Medical University (the First People's Hospital of Lianyungang), Lianyungang, Jiangsu, China
| | - Shuo Yang
- Department of Orthopedic Surgery, Affiliated Lianyungang Hospital of Xuzhou Medical University (the First People's Hospital of Lianyungang), Lianyungang, Jiangsu, China
| | - Jian Yu
- Department of Orthopedic Surgery, Affiliated Lianyungang Hospital of Xuzhou Medical University (the First People's Hospital of Lianyungang), Lianyungang, Jiangsu, China
| | - Shuchang Chen
- Department of Orthopedic Surgery, Affiliated Lianyungang Hospital of Xuzhou Medical University (the First People's Hospital of Lianyungang), Lianyungang, Jiangsu, China
| | - Tao Feng
- Department of Orthopedic Surgery, Affiliated Lianyungang Hospital of Xuzhou Medical University (the First People's Hospital of Lianyungang), Lianyungang, Jiangsu, China
| | - Yongfeng Huo
- Department of Orthopedic Surgery, Affiliated Lianyungang Hospital of Xuzhou Medical University (the First People's Hospital of Lianyungang), Lianyungang, Jiangsu, China
| | - Jian Yin
- Department of Orthopedic Surgery, Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Yanyan Zhang
- Department of Orthopedic Surgery, Affiliated Lianyungang Hospital of Xuzhou Medical University (the First People's Hospital of Lianyungang), Lianyungang, Jiangsu, China.
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Fu BS, Zheng ZH. Surgical Treatments for Femoral Shaft Fractures: A Narrative Review. Malays Orthop J 2023; 17:5-8. [PMID: 38107348 PMCID: PMC10723005 DOI: 10.5704/moj.2311.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/21/2023] [Indexed: 12/19/2023] Open
Abstract
Femoral shaft fractures are increasingly common due to various traumatic injuries. Intramedullary nail (IMN) is considered the gold standard treatment for these fractures, but comorbidities often require thorough trauma life support and intensive care. The primary goal of treatment is rigid fixation, early mobilisation, and long-term functional recovery. This article reviews current concepts in the treatment of femoral shaft fractures, including the effects of early or delayed operation, differences between antegrade or retrograde intramedullary nailing, alternative methods to using a fracture table, methods to predict nail length before operation, assessing femoral rotation during an operation, and complications.
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Affiliation(s)
- B S Fu
- Department of Orthopedic Surgery, Zuoying Branch of Kaohsiung Armed Force General Hospital, Kaohsiung City, Taiwan
| | - Z H Zheng
- Department of Orthopedic Surgery, Hualien Armed Forces General Hospital, Hualien City, Taiwan
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Chang PS, Bechtold D, Kazarian GS, Tian A, Miller AN, McAndrew CM, Inclan PM, Berkes MB. Small residual fracture gaps delay time to union in length stable femur fractures treated with intrameduallary fixation. Injury 2023; 54:687-693. [PMID: 36402583 DOI: 10.1016/j.injury.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate whether residual fracture gapping and translation at time of intramedullary nail (IMN) fixation for diaphyseal femur fractures were associated with delayed healing or nonunion. DESIGN Retrospective cohort study SETTING: Level 1 trauma hospital, quaternary referral center PATIENTS/PARTICIPANTS/INTERVENTION: Length stable Winquist type 1 and 2 diaphyseal femur fractures treated with IMN at a single Level I trauma center were retrospectively reviewed. MAIN OUTCOME MEASURE The largest fracture gap and translation were evaluated on immediate anteroposterior (AP) and lateral postoperative radiographs. Radiographic healing was assessed using Radiographic Union Score in Femur (RUSF) scores at each follow-up. Radiographic union was defined as a RUSF score ≥8 and consolidation of at least 3 cortices. ANOVA and student's t-tests were used to evaluate the influence of fracture gap parameters on time to union (TTU) and nonunion rate. Patients were stratified to measured average gap and translation distances <1mm, 1-3mm and >3mm for portions of the analysis. RESULTS Sixty-six patients who underwent IMN with adequate follow-up were identified. A total of 93.9% of patients achieved union at an average of 2.8 months. Fractures with average AP/lateral gaps of <1mm, 1-2.9 mm, and >3mm had an average TTU of 70.1, 91.7, and 111.9 days respectively; fractures with larger residual gap sizes had a significantly longer TTU (p=0.009). Fractures with an average gap of 1-2.9mm and >3 mm had a significantly higher nonunion rate (1.5% and 4.5% respectively) compared to 0% nonunion in the <1 mm group (p=0.003). CONCLUSION Residual gapping following intramedullary fixation of length stable diaphyseal femur fractures is associated with a significant increase in likelihood of nonunion. SUMMARY Residual displacement of length stable femoral shaft fractures following intramedullary nailing can have a significantly negative impact on fracture healing. An average 3 mm AP/lateral residual fracture gap or a total of 6 mm of the AP + lateral fracture gap appeared to be a critical gap size with increased rates of nonunion and time to union. Therefore, we suggest minimizing the sum of the residual AP and lateral fracture gap to less than a total of 6 mm.
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Affiliation(s)
- Peter S Chang
- Department of Orthopedic Surgery, The Steadman Clinic, Vail, CO, United States.
| | - Daniel Bechtold
- Department of Orthopaedic Surgery, University of Washington, Seattle, WA, United States
| | - Gregory S Kazarian
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - Andrea Tian
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Anna N Miller
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Christopher M McAndrew
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Paul M Inclan
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Marschall B Berkes
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, United States
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Lin CY, Chen CY, Lin KC, Chou YJ, Chang WN. "Fragment Width Ratio" as a Predictor of Nonunion for Femoral Shaft Fracture With Third Fragments. Orthopedics 2023; 46:169-174. [PMID: 37018623 DOI: 10.3928/01477447-20230104-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Previous studies have reported that large fracture fragment with displacement might cause nonunion of femoral shaft fractures. We therefore intended to delineate significant risk factors for developing a nonunion predisposed by a major fracture fragment. We analyzed 61 patients who were operated on using interlocking nails for femoral shaft fractures from 2009 to 2018. We classified patients with modified Radiographic Union Scale for Tibia fractures scores of less than 11 or needing reoperations by 1 year postoperatively as nonunion. We thereafter measured parameters of the displaced fracture fragment and fracture site to identify the significant difference between the union and non-union groups. We also applied the receiver operating characteristic curve to demonstrate a threshold value for the fragment width (FW) ratio. Among 61 patients with complete follow-up, no significant difference was found regarding length, displacement, and angulation of fragments between patients with and without union. Except for higher mean FW (P=.03) and the FW ratio (P=.01) in patients with nonunion, the logistic regression analysis demonstrated that FW ratio significantly affected union (P=.018; odds ratio, 0.21; 95% CI, 0.001-0.522). Although a fracture fragment greater than 4 cm with displacement greater than 2 cm was reported to significantly cause nonunions, our study showed that an FW ratio greater than 0.55 instead of fragment size or displacement was predictive for the occurrence of nonunion adjoining to the fracture site. Fixation of the third fracture fragment should not be ignored for preventing a nonunion. More attention should be paid to achieve a better fixation for a major fracture fragment with an FW ratio greater than 0.55 to avoid the development of non-union following the use of interlocking nail for femoral shaft fracture. [Orthopedics. 202x;xx(x):xx-xx.].
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Tao X, Yang Q. Use of minimally invasive cerclage wiring for displaced major fragments of femoral shaft fractures after intramedullary nailing promotes bone union and a functional outcome. J Orthop Surg Res 2022; 17:533. [PMID: 36503506 PMCID: PMC9743699 DOI: 10.1186/s13018-022-03439-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Femoral shaft fractures caused by high energy trauma can be very challenging due to the large variability in fracture morphology and poor functional outcomes. Displaced major fragments of femoral shaft fractures are difficult to manage after closed reduction and intramedullary nailing (IMN). The minimally invasive cerclage wiring (CW) procedure has become an optimal tool for major fragment resetting and stabilization after IMN. However, arguments continue for the potential risk of arterial injury, blood supply disruption, and delayed bone union or non-union with the CW procedure. The surgical algorithm for treating femoral shaft fractures with displaced major fragments remains controversial. Thus, emphasis is placed on whether the CW procedure can promote the bone union rate and improve functional outcomes without significant complications. METHODS We performed a retrospective study on all patients of femoral shaft fractures with displaced major fragments between June 2015 and August 2019 in our trauma centre. Eligible patients were included and stratified into the CW group and IMN group. Demographics, radiological data, callus formation, union time, and functional outcomes were critically compared between the two groups. RESULTS Thirty-seven patients were included in the present study according to our inclusion/exclusion criteria, of whom 16 (43.2%) were stratified into the CW group, and 21 (56.8%) into the IMN group. The modified radiographic union score for femorae (mRUSH) in the CW group and IMN group was significantly different (11.94 ± 1.29 vs. 7.95 ± 0.74, 6 months; 15.88 ± 0.50 vs. 10.33 ± 0.91, 12 months) (p < 0.0001). The mean union time was significantly different between the CW and IMN groups (7.9 ± 3.2 months vs. 20.1 ± 8.48 months) (p < 0.0001). Bone union at 12 months differed significantly between the CW and IMN groups (15 vs. 5) (p < 0.05). The Harris Hip Score in the CW group was significantly higher than that in the IMN group (88.19 ± 4.69 vs. 76.81 ± 5.26, 12 months; 93.19 ± 4.68 vs. 87.57 ± 5.38, 24 months) (p < 0.01). The Hospital for Special Surgery Knee Score was significantly different between the CW and IMN groups (78.50 ± 5.65 vs. 67.71 ± 4.65, 12 months; 89.50 ± 5.05 vs. 75.81 ± 8.90, 24 months) (p < 0.0001). CONCLUSIONS Minimally invasive CW is an optimal supplement for IMN in the treatment of femoral shaft fractures with displaced major fragments. As illustrated, the benefits of CW potentially include promotion of the bone union rate and improvement in functional outcomes.
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Affiliation(s)
- Xingguang Tao
- grid.413087.90000 0004 1755 3939Department of Orthopedics, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Qingpu District Central Hospital Shanghai, No. 1158, East Gongyuan Road, Qingpu District, 201700 Shanghai, People’s Republic of China
| | - Qing Yang
- grid.413087.90000 0004 1755 3939Department of Orthopedics, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Qingpu District Central Hospital Shanghai, No. 1158, East Gongyuan Road, Qingpu District, 201700 Shanghai, People’s Republic of China
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Yang S, Yang Y, Huo Y, Yu J, Sheng L, Sun X, Liu X, Yin J, Yin Z. Effect of the degree of displacement of the third fragment on healing of femoral shaft fracture treated by intramedullary nailing. J Orthop Surg Res 2022; 17:380. [PMID: 35962386 PMCID: PMC9373464 DOI: 10.1186/s13018-022-03275-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/28/2022] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the effect of the degree of displacement of a femoral shaft fracture with the third fragment on fracture healing after intramedullary nailing.
Methods In total, 216 patients with closed comminuted femoral fracture admitted to Lianyungang Hospital affiliated to Xuzhou Medical University from February 2010 to February 2016 were analyzed retrospectively. Among these patients, 142 were males and 74 were females, the mean age was 38 years (range 17–64 years), and 95 cases were on the right, while 121 cases were on the left. All patients were treated with a femoral interlocking intramedullary nail. Referring to the femoral shaft diameter, the degree of displacement of the third fragment was classified into four grades: grade I (displacement was less than a third of the diameter of the shaft): 121 cases; grade II (greater than a third of the diameter and less than two thirds): 52 cases; grade III (greater than two thirds of the diameter): 28 cases; and grade IV (fracture fragment turnover): 15 cases. According to the modified Radiological Union Scale for Femur (mRUSF), the fracture union rate and the mean union time of the fracture, the effect of the degree of displacement of the third fragment on fracture healing was evaluated.
Results In total, 216 patients with a mean follow-up of 15.9 months (range 6–31 months) met the inclusion criteria. The best fracture healing was the grade I displacement, with a union rate of 89.2% and a mean union time of 7.7 months. The poorest fracture healing was for the grade IV displacement, with a union rate of 13.3% and a mean union time of 16.5 months. The healing was moderate in the grade II and III displacements, with a union rate of 46.2% and 28.6%, respectively, and a mean union time of 8.6 months and 13.5 months, respectively (P < 0.05). Conclusions The third fragment with grade I displacement requires no intervention, whereas fractures with grade IV displacement should be reduced to as near as possible to the diaphyseal bone defect to avoid nonunion. The third fragments with the grade II or III displacement should be treated with closed reduction whenever possible to achieve a displacement within the range of grade I to minimize the incidence of nonunion.
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Affiliation(s)
- Shuo Yang
- Department of Orthopedic Surgery, Lianyungang Hospital, the Affiliated Lianyungang Hospital of Xuzhou Medical University (The First People's Hospital of Lianyungang), Lianyungang, Jiangsu Province, China
| | - Yelin Yang
- Department of Orthopedic Surgery, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yongfeng Huo
- Department of Orthopedic Surgery, Lianyungang Hospital, the Affiliated Lianyungang Hospital of Xuzhou Medical University (The First People's Hospital of Lianyungang), Lianyungang, Jiangsu Province, China
| | - Jian Yu
- Department of Orthopedic Surgery, Lianyungang Hospital, the Affiliated Lianyungang Hospital of Xuzhou Medical University (The First People's Hospital of Lianyungang), Lianyungang, Jiangsu Province, China
| | - Luxin Sheng
- Department of Orthopedic Surgery, Lianyungang Hospital, the Affiliated Lianyungang Hospital of Xuzhou Medical University (The First People's Hospital of Lianyungang), Lianyungang, Jiangsu Province, China
| | - Xiao Sun
- Department of Orthopedic Surgery, Lianyungang Hospital, the Affiliated Lianyungang Hospital of Xuzhou Medical University (The First People's Hospital of Lianyungang), Lianyungang, Jiangsu Province, China
| | - Xinhui Liu
- Department of Orthopedic Surgery, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China.
| | - Jian Yin
- Department of Orthopedic Surgery, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China.
| | - Zhaoyang Yin
- Department of Orthopedic Surgery, Lianyungang Hospital, the Affiliated Lianyungang Hospital of Xuzhou Medical University (The First People's Hospital of Lianyungang), Lianyungang, Jiangsu Province, China.
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Effectiveness and Biomechanical Analysis of the Ortho-Bridge System on Femoral Fracture Healing: A Retrospective Analysis. Indian J Orthop 2022; 56:1795-1803. [PMID: 36187589 PMCID: PMC9485352 DOI: 10.1007/s43465-022-00687-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Among the surgical methods for femoral fractures, the Ortho-Bridge System (OBS) appears to heal fractures via an uncommon process. We compared its effectiveness and biomechanical aspects to those of a locking compression plate (LCP) and explained the healing process demonstrated by the OBS. METHODS Eleven femoral shaft fracture cases treated with OBS between July 2017 and May 2020 were retrospectively reviewed. Clinical and radiographic data were collected during regular postoperative follow-up visits and assessed via the Harris Hip Score and Knee Society Score. We performed biomechanical experiments of OBS. We simulated different fracture conditions and selected appropriate screw holes at the fracture's far and near segments. The OBS module was placed according to the position of LCP's locking hole at both ends of the fracture; then, a static three-point bending test was performed. RESULTS All patients had contralateral callus growth with secondary fracture healing. Healing time was 3-5 months with excellent hip and knee function. When the key screw distance was 22-34 mm, the OBS was significantly less stiff than the LCP (P < 0.05). The stiffness of LCP and OBS decreased significantly when the key screw distance was 49-82 mm, with the LCP being slightly stronger (P < 0.05). CONCLUSIONS Femoral shaft fracture treatment with OBS demonstrated secondary healing. When the distance between the key screws was 20-40 mm, the elasticity was higher in OBS than in LCP, possibly producing axial micro-motion to stimulate callus formation and promote fracture healing, which differ from the plate's primary healing process.
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Surgical outcomes of retrograde nailing enhanced with minimally invasive cerclage cable fixation for infra-isthmal femoral fracture. J Orthop Sci 2022; 27:859-865. [PMID: 34024720 DOI: 10.1016/j.jos.2021.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/09/2021] [Accepted: 03/21/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Infra-isthmal femoral fracture has been known as one of the risk factors for femoral nonunion. Retrograde intramedullary nailing can provide reliable stability of the distal fragment in infra-isthmal femoral fracture, but adequate reduction is required to achieve a successful outcome. This study aimed to evaluate the surgical outcomes of retrograde nailing enhanced with minimally invasive cerclage cable fixation for infra-isthmal femoral fracture. METHODS Between March 2013 and July 2017, 15 patients with infra-isthmal fractures treated with retrograde nailing and minimally invasive cerclage cable fixation were included in this study. Cerclage cable was applied for reduction aid (reduction cable) or prevention of further displacement in non-displaced extension of the distal spiral fracture (prevention cable). Number and function of cerclage cables, operation time, additional surgery, and complications were assessed. Further displacement of the wedge after nailing, coronal and sagittal alignment, displacement of the main fragment, and time from injury to union were evaluated as radiologic outcomes. RESULTS Of the 15 patients in this study, 14 were treated with reduction cables. Average postoperative coronal and sagittal angulation was 1.7° (1° varus to 4° valgus) and 1.6° (2° flexion to 11° extension). Mean displacement between the main fragments was 3.5 mm (range 0-22 mm). Four of the 14 cases used additional prevention cables combined with reduction cable. Only one case was treated solely with a prevention cable. A total of five prevention cables were maintained without further displacement. All patients achieved bone union, and the average time to union was 22.7 weeks (range 9-44 weeks). There were no complications as a result of surgery, such as infection or major neurovascular injury. CONCLUSIONS The minimally invasive cerclage cable technique could be a useful and safe enhancement in retrograde nailing for infra-isthmal femoral fracture in order to prevent further displacement and to reduce the main fracture.
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Tsai YH, Wang TK, Lee PY, Chen CH. The Butterfly Fragment in Wedge-Shaped Femoral Shaft Fracture: Comparison of Two Different Surgical Methods. Orthop Surg 2022; 14:1663-1672. [PMID: 35732296 PMCID: PMC9363744 DOI: 10.1111/os.13372] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 05/12/2022] [Accepted: 05/24/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Our study compared the results of wedge‐shaped femoral shaft fracture following intramedullary (IM) nailing with or without fixation of the third fragment. Methods We retrospectively reviewed patients presenting with femoral shaft fracture with AO/OTA type 32‐B from 2011 to 2016. Patients were divided into two groups: closed reduction without touching the third fragment and open reduction with fixation of the third fragment. The fragment ratio, fragment length, nail size, dynamization or not, mRUST scores, union rate, and union time were compared between the two groups. Risk factors of non‐union were also investigated, including sex, age, fracture pattern, fracture location, dynamization, nail size, fragment ratio, fragment size, and postoperative fragment displacement. Results A total of 80 patients met inclusion criteria, 20 patients with wedge‐shaped shaft femoral fracture were managed with IM nailing and open reduction with fixation of the third fragment. Sixty patients were treated with IM nail without touching the third fragment. The union rate for the fixation and non‐fixation groups were 60.0% and 81.7%, respectively. The mean union time for the fixation group was 19 months vs 14 months for the non‐fixation group. Multi‐regression analysis showed larger nail size (odds ratio: 2.26) and fixation of the third fragment (odds ratio: 0.18) influenced fracture healing. Conclusions Fixation of the third fragment in wedge‐shaped shaft femoral fracture results in a longer union time and lower union rate. In the management of femoral fracture with a third fragment, a larger nail size is recommended and fixation should be performed in a closed manner. Fixation of the fragment may achieve better fracture reduction. However, disruption of the vasculature and surrounding structures may further result in nonunion of the fracture site.
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Affiliation(s)
- Yuan-Hsin Tsai
- Department of Orthopaedics, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Teng-Kuan Wang
- Department of Orthopaedics, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Pei-Yuan Lee
- Department of Orthopaedics, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Chih-Hui Chen
- Department of Orthopaedics, Changhua Christian Hospital, Changhua city, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Chen YH, Liao HJ, Lin SM, Chang CH, Rwei SP, Lan TY. Radiographic outcomes of the treatment of complex femoral shaft fractures (AO/OTA 32-C) with intramedullary nailing: a retrospective analysis of different techniques. J Int Med Res 2022; 50:3000605221103974. [PMID: 35676773 PMCID: PMC9189532 DOI: 10.1177/03000605221103974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To assess the results of open versus closed reduction in intramedullary nailing (IMN) for complex femoral fractures (Arbeitsgemeinschaft für Osteosynthesefragen Foundation/Orthopaedic Trauma Association [AO/OTA]: 32-C) and to determine the factors involved in bone healing. METHODS This retrospective study involved 47 consecutive patients with complex femoral diaphyseal fractures who underwent reduction and fixation. RESULTS All open-reduction and 12 closed-reduction patients (52.17%) had an anatomical-to-small gap. The closed-small group had the highest bone union rate (100%), followed by the open-reduction (79.17%) and closed-large groups (72.73%); intergroup differences were significant. The closed-small group had the shortest mean union time (7.31 months), followed by the open-reduction group (7.58 months). The closed-large group had a significantly longer union time (9.75 months) than those in the closed-small and open-reduction groups. Femoral radiographic union scores in the closed-small and open-reduction groups were similar at three timepoints; scores were higher than those in the closed-large group, with a significant difference 6 and 9 months post-operatively. CONCLUSION IMN with closed reduction for complex femoral shaft fractures had better outcomes and fewer complications versus open reduction. For unsatisfactory closed reduction outcomes (i.e., residual gap >10 mm), minimally invasive techniques or open reduction with minimal stripping should be considered.
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Affiliation(s)
- Yu-Hung Chen
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City
| | - Hsiu-Jung Liao
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City
| | - Shang Ming Lin
- Department of Materials and Textiles, Asia Eastern University of Science and Technology, No. 58, Sec. 2, Sihchuan Rd., New Taipei City
| | - Chih-Hung Chang
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City
| | - Syang-Peng Rwei
- Institute of Organic and Polymeric Materials, National Taipei University of Technology, 1, Sec. 3, Zhongxiao E. Rd., Taipei.,Research and Development Center for Smart Textile Technology, National Taipei University of Technology, 1, Sec. 3, Zhongxiao E. Rd., Taipei
| | - Tsung-Yu Lan
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., New Taipei City.,Department of Materials and Textiles, Asia Eastern University of Science and Technology, No. 58, Sec. 2, Sihchuan Rd., New Taipei City.,Institute of Organic and Polymeric Materials, National Taipei University of Technology, 1, Sec. 3, Zhongxiao E. Rd., Taipei
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Peng C, Ren G, Dou M, Yuan B, Wu D. Minimally invasive plate osteosynthesis for complex comminuted bone fractures in the Fraser's type II floating knee: a case report. Eur J Med Res 2022; 27:31. [PMID: 35236403 PMCID: PMC8889746 DOI: 10.1186/s40001-022-00649-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
Objective Floating knee type IIC, according to Fraser’s classification, is an uncommon severe injury that typically occurs in polytrauma. In such cases, intra-articular fracture and the high degree of comminution and deformity of the mid-distal femur make fixation challenging. The purpose of this study was to demonstrate that minimally invasive plate osteosynthesis (MIPO) technology can simplify these complex problems and improve patient prognosis. Case presentation A 38-year-old man injured his left leg in a car accident, causing pain, swelling, deformity, and limited mobility on his left knee and thigh, and two small open wounds were noted mainly of the anterior aspect of the mid-distal thigh. Physical examination and computed tomography angiography of the lower limb confirmed that there was no damage to the neurovascular system. The clinical diagnosis was closed intra-articular fracture of the proximal tibia, open intra-articular fracture of the distal femur with extension to the diaphysis, and a patellar fracture on the ipsilateral knee. The treatment strategy involved a locking plate system applying MIPO technology. Postoperative evaluation of the patient was satisfactory, with immediate functional exercise, full weight-bearing after three months, and return to daily activity without pain. Final follow-up taken 3 years after surgery showed good lower limb alignment and complete plasticity of the bone structure, by which time the patient showed good limb function. Conclusions Minimally invasive techniques can provide a simple and effective treatment for some complex fractures.
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Affiliation(s)
- Chuangang Peng
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No 218, Lane Ziqiang, Nanguan District, Changchun, 130041, People's Republic of China
| | - Guangkai Ren
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No 218, Lane Ziqiang, Nanguan District, Changchun, 130041, People's Republic of China
| | - Minghan Dou
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No 218, Lane Ziqiang, Nanguan District, Changchun, 130041, People's Republic of China
| | - Baoming Yuan
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No 218, Lane Ziqiang, Nanguan District, Changchun, 130041, People's Republic of China.
| | - Dankai Wu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, No 218, Lane Ziqiang, Nanguan District, Changchun, 130041, People's Republic of China.
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Wang TH, Chuang HC, Kuan FC, Hong CK, Yeh ML, Su WR, Hsu KL. Role of open cerclage wiring in patients with comminuted fractures of the femoral shaft treated with intramedullary nails. J Orthop Surg Res 2021; 16:480. [PMID: 34364374 PMCID: PMC8348994 DOI: 10.1186/s13018-021-02633-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/24/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction The role of open cerclage wiring in comminuted femoral shaft fracture treatment with intramedullary nails remains unclear. Here, we analyzed the effect of open cerclage wiring and the risk factors for nonunion after interlocking nailing in comminuted femoral shaft fracture treatment. We hypothesized that open cerclage wiring can be applied in patients with severe comminuted femoral shaft fractures without affecting bone healing. Patients and methods This retrospective cohort study used data from consecutive patients who underwent interlocking nail fixation of a comminuted femoral shaft fracture between January 1, 2009, and December 31, 2016. First, eligible patients were divided into the wire and no wire groups according to the surgical technique used, and their union rate was recorded. The patients were then divided into the union and nonunion groups, and their perioperative data were analyzed. Results In total, 71 comminuted femoral shaft fractures treated with interlocking nail fixation were included: 38 fractures (53.5%) augmented with the open wiring technique and 33 reduced with closed or mini-open techniques without wiring. The wire group demonstrated significant improvements in fracture reduction compared with the no wire group, whereas no significant difference was observed in the union rate between the wire and no wire groups (p = 0.180). Moreover, 46 (65%) of 71 fractures achieved union smoothly, and no significant difference was observed in any perioperative data between the union and nonunion groups. Discussion Augmentation with open cerclage wiring is indicated for comminuted femoral shaft fractures treated with intramedullary nails, even when the fragments are large or greatly displaced. Thus, open cerclage wiring can be used for fracture treatment without decreasing the union rate.
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Affiliation(s)
- Tzu-Hao Wang
- Department of Orthopaedics, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan, R.O.C.,Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, R.O.C.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung, Tainan, Taiwan, R.O.C
| | - Hao-Chun Chuang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, R.O.C.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung, Tainan, Taiwan, R.O.C
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, R.O.C.,Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan, R.O.C.,Division of Traumatology, National Cheng Kung University Medical Center, Tainan, Taiwan, R.O.C.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung, Tainan, Taiwan, R.O.C
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, R.O.C.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung, Tainan, Taiwan, R.O.C
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan, R.O.C
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, R.O.C.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung, Tainan, Taiwan, R.O.C
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, R.O.C.. .,Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan, R.O.C.. .,Division of Traumatology, National Cheng Kung University Medical Center, Tainan, Taiwan, R.O.C.. .,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung, Tainan, Taiwan, R.O.C..
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Layon D, Morrell AT, Lee C. The flipped third fragment in femoral shaft fractures: A reason for open reduction? Injury 2021; 52:589-593. [PMID: 32998826 DOI: 10.1016/j.injury.2020.09.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/17/2020] [Accepted: 09/22/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES First introduced by Kuntscher in the 1940s, closed intramedullary nailing of femoral shaft fractures has become the standard of care, with reported union rates up to 99% in some series. However, fractures with large intercalary segments, which are present in 10-34% of femoral shaft fractures, present unique challenges. In particular, how to treat flipped intercalary segments has remained controversial, with some advocating open reduction of these fractures. The purpose of this study was to evaluate the union rates of femoral shaft fractures with flipped intercalary segments treated with closed reduction and intramedullary nail fixation. METHODS A retrospective review of patients with femoral shaft fractures and flipped intercalary segments from January 2000 until January 2018 was performed at a single academic level one tertiary care referral center. All patients between the ages of 16-80 with minimum 6-month follow-up were included. Union rates were evaluated using the radiographic union score of the femur (RUSF). Patients with non-diaphyseal femur fractures, pathologic fractures, incomplete radiographic or clinical follow-up, or open reduction at the time of initial surgery were excluded. RESULTS Twenty-six patients (18 male and 8 female) with a mean age of 32 years (SD 12.8, range 19-65 years) and mean follow-up of 15.9 months (range, 6-82 months) met inclusion criteria. Seven patients had open fractures. The mean size of the flipped intercalary segments was 71.3 mm (range: 30-174 mm), with mean displacement of 6.6 mm (range: 1-37 mm). The mean radiographic union scale in femoral (RUSF) at 6 months was 9 (standard deviation: 1.35). There were two patients who went on to non-union. The overall union rate was 92% (24 patients); the non-union rate was 8% (2 patients). CONCLUSIONS Though uncommon, femoral shaft fractures with flipped intercalary segments present unique challenges to surgical treatment. While previous studies have found the presence of large intercalary segments to be associated with higher rates of non-union, the results of this study challenge prior evidence. In conclusion, the presence of flipped intercalary segments may not require different surgical management than the treatment of conventional femoral shaft fractures. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Daniel Layon
- Virginia Commonwealth University, Department of Orthopaedic Surgery, PO Box 980153, 1200 East Broad Street, Richmond, VA 23298, United States
| | - Aidan T Morrell
- Virginia Commonwealth University, School of Medicine, 1201 E Marshall St, #4-100, Richmond, VA 23298, United States
| | - Christopher Lee
- University of California Los Angeles, Department of Orthopaedic Surgery, 10833 Le Conte Ave, Los Angeles, CA 90095, United States.
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Association Between Femoral "Spike" Size After Intramedullary Nailing and Subsequent Knee Motion Surgery. J Orthop Trauma 2021; 35:100-105. [PMID: 32658018 DOI: 10.1097/bot.0000000000001893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the association between displaced femoral shaft bone fragments ("spikes") seen on radiographs after intramedullary nail insertion and the need for future motion surgery. DESIGN Retrospective case-control study. SETTING Academic trauma center. PATIENTS We included patients with femoral shaft fractures treated with intramedullary nail insertion. Case patients (n = 22) had developed knee stiffness treated with motion surgery. The control group was a randomly selected sample (1:3 ratio). MAIN OUTCOME MEASURES Motion surgery to address knee stiffness. We defined a "spike distance ratio" and "spike area ratio" from initial postoperative anteroposterior and lateral radiographs. Multivariable logistic regression determined the effect of spike distance and area ratios on the likelihood of need for motion surgery, controlling for polytraumatic injuries and bilateral fractures. RESULTS The case group had a median femoral spike distance ratio of 1.9 [interquartile range (IQR), 1.6-2.5] compared with 1.5 (IQR, 1.2-1.8) in the control group. An increased femoral spike distance ratio was associated with increased odds of motion surgery (P < 0.01). A femoral spike distance >2 times the femoral radius had 32 times the odds (95% confidence interval, 2-752) of motion surgery compared with patients with distance ratios <1.25. Median femoral spike area ratios were similar between the case (0.2; IQR, 0.1-0.5) and control (0.2; IQR, 0.0-0.5) groups and were not associated with increased odds of motion surgery (P = 0.34). CONCLUSIONS A larger spike distance ratio is associated with increased odds of subsequent motion surgery. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Abstract
PURPOSE OF REVIEW The failure of bony union following a fracture, termed a fracture nonunion, has severe patient morbidity and economic consequences. This review describes current consensuses and future directions of investigation for determining why, detecting when, and effective treatment if this complication occurs. RECENT FINDINGS Current nonunion investigation is emphasizing an expanded understanding of the biology of healing. This has led to assessments of the immune environment, multiple cytokines and morphogenetic factors, and the role of skeletogenic stem cells in the development of nonunion. Detecting biological markers and other objective diagnostic criteria is also a current objective of nonunion research. Treatment approaches in the near future will likely be dominated by the development of specific adjunct therapies to the nonunion surgical management, which will be informed by an expanded mechanistic understanding of nonunion biology. Current consensus among orthopedists is that improved diagnosis and treatment of nonunion hinges first on discoveries at the bench side with later translation to the clinic.
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Affiliation(s)
- G Bradley Reahl
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, 02118, USA.
| | - Louis Gerstenfeld
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Michael Kain
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, 02118, USA.
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Herrera A, Rosell J, Ibarz E, Albareda J, Gabarre S, Mateo J, Gracia L. Biomechanical analysis of the stability of anterograde reamed intramedullary nails in femoral spiral fractures. Injury 2020; 51 Suppl 1:S74-S79. [PMID: 32081396 DOI: 10.1016/j.injury.2020.02.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/09/2020] [Indexed: 02/02/2023]
Abstract
Femoral shaft fractures present high morbidity and important complications and consequences, being spiral fractures the most complicated from a biomechanical point of view, being unstable and without possibility of getting a good contact between nail and femoral endosteum. Femoral diaphyseal fractures are treated, usually, by means of intramedullary nailing. So, it is necessary to know the osteosynthesis stability and which locking screws combination is optimal. This work studies the use of reamed locked intramedullary nails in spiral femoral fractures located along zones 2 and 4 of wiss, depending on the spire length, corresponding to 32-A spiral type in AO/OTA classification, which represent a percentage of 23% within the total of diaphyseal fractures. A three-dimensional finite element model of the femur was developed, modeling a spiral fracture with different spiral lengths and gaps. A femoral nail was used, considering two transversal screws both at the proximal and the distal parts. The study was focused on the immediately post-operative stage, verifying the appropriate stability of the osteosynthesis. Reamed intramedullary blocked nails provide appropriate stability of femoral spiral fractures, considering global mobility of femoral head with respect to femoral condyles, relative displacements between fragments at fracture site, stresses at nail and locking screws, and stresses at cortical bone. The obtained results show that the use of blocked reamed nails in spiral femoral fractures can be considered as an appropriate surgical technique, providing sufficient stability in order to obtain an adequate fracture healing.
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Affiliation(s)
- A Herrera
- Aragón Health Research Institute. Zaragoza, Spain; Department of Surgery, University of Zaragoza. Zaragoza, Spain
| | - J Rosell
- Department of Mechanical Engineering, University of Zaragoza. Zaragoza, Spain
| | - E Ibarz
- Department of Mechanical Engineering, University of Zaragoza. Zaragoza, Spain; Aragón Institute for Engineering Research. Zaragoza, Spain
| | - J Albareda
- Aragón Health Research Institute. Zaragoza, Spain; Department of Surgery, University of Zaragoza. Zaragoza, Spain; Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital. Zaragoza, Spain
| | - S Gabarre
- Vlaams Instituut voor Biotechnologie, Leuven, Belgium
| | - J Mateo
- Aragón Health Research Institute. Zaragoza, Spain; Department of Surgery, University of Zaragoza. Zaragoza, Spain; Department of Orthopaedic Surgery and Traumatology, Miguel Servet University Hospital. Zaragoza, Spain
| | - L Gracia
- Department of Mechanical Engineering, University of Zaragoza. Zaragoza, Spain; Aragón Institute for Engineering Research. Zaragoza, Spain.
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Hamahashi K, Uchiyama Y, Kobayashi Y, Ebihara G, Ukai T, Watanabe M. Clinical outcomes of intramedullary nailing of femoral shaft fractures with third fragments: a retrospective analysis of risk factors for delayed union. Trauma Surg Acute Care Open 2019; 4:e000203. [PMID: 31058233 PMCID: PMC6461209 DOI: 10.1136/tsaco-2018-000203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/13/2018] [Accepted: 02/25/2019] [Indexed: 01/26/2023] Open
Abstract
Background This study retrospectively evaluated the clinical outcomes of intramedullary nailing of femoral shaft fractures with third fragments and analyzed the risk factors for delayed union. Methods Retrospective analyses involving 51 patients who underwent intramedullary nailing of femoral shaft fractures with third fragments (AO classification type B, 35 cases; type C, 16 cases) were conducted. Delayed union was defined as either more than 10 months required for callus formation in more than three of the four cortical bone surfaces observed in the frontal and lateral radiographic views or the requirement for additional surgery such as nail conversion or bone transplantation. Seventeen patients developed delayed union (D group). Thirty-four patients achieved bony union within 9 months (U group). The following background variables were compared between groups: age at the time of the injury; AO classification; ratio of open fracture; waiting period before surgery; rate of the infraisthmal fracture; diameter of the intramedullary nail; ratio of the intramedullary nail to the femur; length and displacement of the third fragment; and use of open reduction, poller screws, or dynamization. Results Significant differences were found between the D and U groups for age (32.2±14.1 vs. 25.3±9.6 years), open fracture ratio (35.3% vs. 11.8%), and displacement of the third fragment (13.7±6.4 vs. 9±6.3 mm). Multiple logistic regression analysis only identified displacement of the third fragment as a risk factor for delayed union (p=0.03; OR 1.13; 95% CI 1.01 to 1.26). Discussion Delayed union was observed in 17 cases (33.3%) after intramedullary nailing of femoral shaft fractures with third fragments. Displacement of the third fragment influenced delayed union. Level of evidence Level III.
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Affiliation(s)
- Kosuke Hamahashi
- Department of Orthopaedic Surgery, SurgicalScience, Tokai University School of Medicine, Isehara, Japan
| | - Yoshiyasu Uchiyama
- Department of Orthopaedic Surgery, SurgicalScience, Tokai University School of Medicine, Isehara, Japan
| | - Yuka Kobayashi
- Department of Orthopaedic Surgery, SurgicalScience, Tokai University School of Medicine, Isehara, Japan
| | - Goro Ebihara
- Department of Orthopaedic Surgery, SurgicalScience, Tokai University School of Medicine, Isehara, Japan
| | - Taku Ukai
- Department of Orthopaedic Surgery, SurgicalScience, Tokai University School of Medicine, Isehara, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, SurgicalScience, Tokai University School of Medicine, Isehara, Japan
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Vicenti G, Carrozzo M, Bizzoca D, Moretti B. Reply to "Letter to the Editor on: The impact of the third fragment features on the healing of femoral shaft fractures managed with intramedullary nailing: a radiological study". INTERNATIONAL ORTHOPAEDICS 2019; 43:1545. [PMID: 30798350 DOI: 10.1007/s00264-019-04313-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 02/13/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Giovanni Vicenti
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro"-AOU Consorziale "Policlinico", Bari, Italy
| | - Massimiliano Carrozzo
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro"-AOU Consorziale "Policlinico", Bari, Italy.
| | - Davide Bizzoca
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro"-AOU Consorziale "Policlinico", Bari, Italy
| | - Biagio Moretti
- Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro"-AOU Consorziale "Policlinico", Bari, Italy
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Lin SJ, Liaw K, Huang TW. Letter to the Editor on "The impact of the third fragment features on the healing of femoral shaft fractures managed with intramedullary nailing: a radiological study". INTERNATIONAL ORTHOPAEDICS 2019; 43:1543-1544. [PMID: 30645686 DOI: 10.1007/s00264-019-04293-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 01/02/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Shih-Jie Lin
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No. 6, West Section, Chia-Pu Road, Pu-Tz City, 61363, Chia-Yi Hsien, Taiwan
| | - Kevin Liaw
- Department of Diagnostic Radiology, Blount Memorial Hospital, Maryville, TN, 37804, USA
| | - Tsan-Wen Huang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No. 6, West Section, Chia-Pu Road, Pu-Tz City, 61363, Chia-Yi Hsien, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan.
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Vicenti G, Carrozzo M, Caiaffa V, Abate A, Solarino G, Bizzoca D, Maddalena R, Colasuonno G, Nappi V, Rifino F, Moretti B. The impact of the third fragment features on the healing of femoral shaft fractures managed with intramedullary nailing: a radiological study. INTERNATIONAL ORTHOPAEDICS 2018; 43:193-200. [PMID: 30488127 DOI: 10.1007/s00264-018-4214-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 09/18/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Femoral shaft fractures with third fragments have a high non-union rate, which may reach 14%. This study aims to assess the impact of the radiological features of the third fragment, evaluated on post-operative X-rays, on the outcome of femoral shaft fractures type 32-B managed with intramedullary nailing, in order to obtain an algorithm which could predict the fracture healing time. MATERIALS AND METHODS We have retrospectively evaluated a series of 52 patients. On post-operative X-rays, four radiological parameters were evaluated: the third fragment angle, the fracture gap, the third fragment size, and the mean third fragment displacement. All the patients underwent a radiologic follow-up at one, two, three, six, nine and 12 months post-operatively, to assess the bone healing. The patients were then divided into three groups, according to the fracture healing time: within six months (group A), between six and 12 months (group B), or fracture non-union after 12 months (group C). RESULTS In 28 patients, out of 52 (53.85%), the fracture healing was observed at 6-month follow-up; in 18 patients, out of 52 (34.62%), the fracture healed within 12 months after trauma; and in six patients, out of 52 (11.54%), no fracture healing was observed at 12-month follow-up. The mean third fragment size was significantly different in each group (p < 0.05), while the mean third fragment displacement was significantly higher in group C, compared with group A (p = 0.0006) and group B (p = 0.0027). In group B, a positive correlation was found between the fracture healing time and the mean third fragment size (R = 0.594, p = 0.036); in group C, the fracture union time was positively related to the third fragment size (R = 0.689, p = 0.013) and the mean third fragment displacement (R = 0.7107, p = 0.006). Regression analysis showed that the third fragment size and the mean third fragment displacement are the most important features which affect the fracture healing time. CONCLUSIONS The third fragment size (cutoff 40 mm) is the leading parameter to influence the fracture healing within or in more than six months. The mean third fragment displacement (cutoff 12 mm); on the other hand, impacts on the fracture delayed rather than absent healing.
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Affiliation(s)
- Giovanni Vicenti
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy
| | - Massimiliano Carrozzo
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy.
| | - Vincenzo Caiaffa
- Department of Orthopaedics and Traumatology, Di Venere Hospital, Bari, Italy
| | - Antonella Abate
- Department of Orthopaedics and Traumatology, Di Venere Hospital, Bari, Italy
| | - Giuseppe Solarino
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy
| | - Davide Bizzoca
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy
| | - Roberto Maddalena
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy
| | - Giulia Colasuonno
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy
| | - Vittorio Nappi
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy
| | - Francesco Rifino
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy
| | - Biagio Moretti
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy
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Cheng T, Xia RG, Dong SK, Yan XY, Luo CF. Interlocking Intramedullary Nailing Versus Locked Dual-Plating Fixation for Femoral Shaft Fractures in Patients with Multiple Injuries: A Retrospective Comparative Study. J INVEST SURG 2017; 32:245-254. [PMID: 29252044 DOI: 10.1080/08941939.2017.1400131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Intramedullary nailing (IMN) is a popular method in the management of femoral shaft fractures (FSFs). However, whether the association of IMN with pulmonary fat emboli can compromise the pulmonary and nervous systems is debatable. The purpose of this study is to compare IMN with the locked dual plating (LDP) method by assessing the clinical outcomes of FSF patients with head or chest injury. METHOD A total of 126 FSF patients were included in this study between January 2010 and July 2016 and divided into LDP and IMN groups. Patient demographic characteristics, operative time, blood loss, Harris Hip Score, Lysholm Knee Score, radiological outcomes, and systemic complications were collected and compared between the two treatment groups. Patients were followed up for at least 12 months. RESULTS The LDP group performed better than IMN in terms of operative time, estimated blood loss amount, and malunion rate. Differences in function scores, fracture union rate, overall pulmonary complication rate, and in-hospital mortality between the two groups were not significant. Average radiographic union time was significantly longer in the LDP group (36.3 weeks) than in the IMN group (32.5 weeks). One case of fixation failure occurred postoperatively in the LDP group, whereas one case of fracture nonunion took place in the IMN group. CONCLUSION Our findings suggest that dual-plating fixation is a promising method for FSFs with multiple injuries. However, the retrospective nature of this study necessitates high-quality trials to be performed to assess the clinical efficiency of dual plating.
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Affiliation(s)
- Tao Cheng
- a Department of Orthopaedic Surgery , Shanghai Jiao Tong University affiliated Shanghai Sixth People's Hospital , Shanghai , People's Republic of China
| | - Rong-Gang Xia
- a Department of Orthopaedic Surgery , Shanghai Jiao Tong University affiliated Shanghai Sixth People's Hospital , Shanghai , People's Republic of China
| | - Shi-Kui Dong
- a Department of Orthopaedic Surgery , Shanghai Jiao Tong University affiliated Shanghai Sixth People's Hospital , Shanghai , People's Republic of China
| | - Xiao-Yu Yan
- a Department of Orthopaedic Surgery , Shanghai Jiao Tong University affiliated Shanghai Sixth People's Hospital , Shanghai , People's Republic of China
| | - Cong-Feng Luo
- a Department of Orthopaedic Surgery , Shanghai Jiao Tong University affiliated Shanghai Sixth People's Hospital , Shanghai , People's Republic of China
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Cheng T, Xia R, Yan X, Luo C. Double-plating fixation of comminuted femoral shaft fractures with concomitant thoracic trauma. J Int Med Res 2017; 46:440-447. [PMID: 28758848 PMCID: PMC6011299 DOI: 10.1177/0300060517720317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective This study was performed to evaluate the clinical outcomes in adult polytraumatized patients with thoracic injury and femoral shaft fractures treated with double-plating fixation. Methods From November 2010 to October 2014, 15 polytraumatized patients with femoral shaft fractures were enrolled in this retrospective study. Radiographic findings and functional outcomes were assessed at 1, 3, 6, and 12 months postoperatively. Results Fourteen (93%) of the 15 femoral shaft fractures achieved bony union, with a mean time to union of 9.2 months. The mean Nonarthritic Hip Score and Lysholm Knee Score was 89.4 and 87.2 points, respectively. The range of motion of the knee joint was comparable between the injured and uninjured legs (116° and 121°, respectively). Conclusions Our findings suggest that lower limb function returns to normal after orthogonal double-plating fixation, which is an alternative technique to intramedullary nailing for femoral diaphyseal fractures in patients with severe chest injury.
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Affiliation(s)
- Tao Cheng
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital affiliated to Shanghai Jiaotong University, People's Republic of China
| | - Ronggang Xia
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital affiliated to Shanghai Jiaotong University, People's Republic of China
| | - Xiaoyu Yan
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital affiliated to Shanghai Jiaotong University, People's Republic of China
| | - Congfeng Luo
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital affiliated to Shanghai Jiaotong University, People's Republic of China
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Yoon RS, Gage MJ, Galos DK, Donegan DJ, Liporace FA. Trochanteric entry femoral nails yield better femoral version and lower revision rates-A large cohort multivariate regression analysis. Injury 2017; 48:1165-1169. [PMID: 28365071 DOI: 10.1016/j.injury.2017.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 03/09/2017] [Accepted: 03/15/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Intramedullary nailing (IMN) has become the standard of care for the treatment of most femoral shaft fractures. Different IMN options include trochanteric and piriformis entry as well as retrograde nails, which may result in varying degrees of femoral rotation. The objective of this study was to analyze postoperative femoral version between three types of nails and to delineate any significant differences in femoral version (DFV) and revision rates. MATERIALS & METHODS Over a 10-year period, 417 patients underwent IMN of a diaphyseal femur fracture (AO/OTA 32A-C). Of these patients, 316 met inclusion criteria and obtained postoperative computed tomography (CT) scanograms to calculate femoral version and were thus included in the study. In this study, our main outcome measure was the difference in femoral version (DFV) between the uninjured limb and the injured limb. The effect of the following variables on DFV and revision rates were determined via univariate, multivariate, and ordinal regression analyses: gender, age, BMI, ethnicity, mechanism of injury, operative side, open fracture, and table type/position. Statistical significance was set at p<0.05. RESULTS A total of 316 patients were included. Piriformis entry nails made up the majority (n=141), followed by retrograde (n=108), then trochanteric entry nails (n=67). Univariate regression analysis revealed that a lower BMI was significantly associated with a lower DFV (p=0.006). Controlling for possible covariables, multivariate analysis yielded a significantly lower DFV for trochanteric entry nails than piriformis or retrograde nails (7.9±6.10 vs. 9.5±7.4 vs. 9.4±7.8°, p<0.05). Using revision as an endpoint, trochanteric entry nails also had a significantly lower revision rate, even when controlling for all other variables (p<0.05). CONCLUSION Comparative, objective comparisons between DFV between different nails based on entry point revealed that trochanteric nails had a significantly lower DFV and a lower revision rate, even after regression analysis. However, this is not to state that the other nail types exhibited abnormal DFV. Translation to the clinical impact of a few degrees of DFV is also unknown. Future studies to more in-depth study the intricacies of femoral version may lead to improved technology in addition to potentially improved clinical outcomes.
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Affiliation(s)
- Richard S Yoon
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Jersey City Medical Center-RWJBarnabas Health, Jersey City, NJ, United States
| | - Mark J Gage
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, United States
| | - David K Galos
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Jersey City Medical Center-RWJBarnabas Health, Jersey City, NJ, United States
| | - Derek J Donegan
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Frank A Liporace
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Jersey City Medical Center-RWJBarnabas Health, Jersey City, NJ, United States.
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Memarzadeh A, Tissingh EK, Hull P, Trompeter A. Intramedullary nailing of femoral shaft fractures in adults. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.mporth.2016.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jiang Y, Guo YF, Meng YK, Zhu L, Chen AM. A report of a novel technique: The comprehensive fibular autograft with double metal locking plate fixation (cFALP) for refractory post-operative diaphyseal femur fracture non-union treatment. Injury 2016; 47:2307-2311. [PMID: 27469400 DOI: 10.1016/j.injury.2016.07.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/06/2016] [Accepted: 07/19/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The refractory post-operative diaphyseal femur fracture (DFF) non-union is extremely difficult to treat and remains severe challenges for orthopedists. Although several traditional internal fixations and novel biomedical techniques have been used in managing this complication, its treatment is still fraught with severe challenges. PATIENTS AND METHODS Starting from 1999, 5 patients after three previous internal fixation operations showing refractory DFF non-union underwent the comprehensive fibular autograft with double metal locking plates fixation (cFALP) surgery. The autogenous fibular was first harvested and non-evenly split into two halves in a longitudinal manner. After retracting all previous internal fixation(s), the larger half strut fibula was hammered into the femur canal while the smaller half was fragmented into small pieces and filled surrounding the DFF site. Two locking compression plate were fixed on the lateral and anterior (or antero-lateral) side of the femur, respectively. RESULTS The follow-up ranged from 60 to 96 weeks. All cases (100%) achieved bony union without severe complications. The mean time to union was 36±14.7 weeks (range 24-60 weeks). CONCLUSION The cFALP is a promising surgical modality for DFF non-union treatment. However, because fibular harvest may cause severe complications, the cFLAP should only be considered in refractory DFF non-union cases.
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Affiliation(s)
- Ying Jiang
- Department of Medicine, New Jersey Medical School Affiliated to Rutgers University, Newark, NJ 07103, United States; Department of Neurosurgery, Shanghai Chang Zheng Hospital Affiliated to China Second Military Medical University, 415 Feng Yang Rd., 200003, Shanghai, PR China.
| | - Yong-Fei Guo
- Department of Orthopedic, Shanghai Chang Zheng Hospital Affiliated to China Second Military Medical University, 415 Feng Yang Rd., 200003, Shanghai, PR China.
| | - Ya-Ke Meng
- Department of Orthopedic, Shanghai Chang Zheng Hospital Affiliated to China Second Military Medical University, 415 Feng Yang Rd., 200003, Shanghai, PR China.
| | - Lei Zhu
- Department of Orthopedic, Shanghai Chang Zheng Hospital Affiliated to China Second Military Medical University, 415 Feng Yang Rd., 200003, Shanghai, PR China.
| | - Ai-Ming Chen
- Department of Orthopedic, Shanghai Chang Zheng Hospital Affiliated to China Second Military Medical University, 415 Feng Yang Rd., 200003, Shanghai, PR China.
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Lin SJ, Huang KC, Chuang PY, Lee CY, Huang TW, Lee MS, Hsu RWW. The outcome of unstable proximal femoral fracture treated with reverse LISS plates. Injury 2016; 47:2161-2168. [PMID: 27435361 DOI: 10.1016/j.injury.2016.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/16/2016] [Accepted: 07/07/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Russel-Taylor type 2B fractures compromised the trochanteric region and medial buttress of proximal femur. This fracture pattern limits the choice of implants and raises the risk of adverse outcomes. We aimed to (i) determine the outcome of Russel-Taylor type 2B fractures treated using reverse less invasive stabilization system plates (LISS-DF) and to (ii) learn what factors affected outcomes after osteosynthesis with reverse LISS plates. DESIGN A retrospective study SETTING: The study was conducted at a Level III trauma center in Taiwan. METHODS Twenty-five consecutive patients presenting with a Russel-Taylor type 2B fracture were enrolled. All cases were treated with reverse LISS plates. A Modified Radiographic Union Scale for Femur (RUSF), Radiographic parameters, functional scores, and complications were assessed. RESULTS Union occurred in 21 cases at an average of 18.8 weeks. The average immediate postoperative neck-shaft angle was 130° (range: 122-135°) compared with 139° (range: 135-141°, p=0.05) on the contralateral side. Two cases had complications of proximal screws cutting out and two cases had broken implants. Finally, all 4 cases required repeated surgeries (16%). Malunion occurred in 4 patients and early mechanical failure (proximal screws cut out) occurred in 2. There was a significant difference in the purchase index of the proximal screws between cases with redisplacement and those without (26.4mm and 98.6mm, p=0.01). CONCLUSIONS The use of reverse LISS plate appeared to be an alternative procedure for the specific pattern in the present study. We recommend using this reverse locking plate to treat unstable proximal femoral fractures with meticulous techniques of placing plates. Adequate purchase of the proximal locking screws might decrease the risks of complications.
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Affiliation(s)
- Shih-Jie Lin
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Kuo-Chin Huang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; Change Gung University, Taoyuan, Taiwan
| | - Po-Yao Chuang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chien-Yin Lee
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Tsan-Wen Huang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; Change Gung University, Taoyuan, Taiwan.
| | - Mel S Lee
- Change Gung University, Taoyuan, Taiwan; Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Taiwan.
| | - Robert Wen-Wei Hsu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; Change Gung University, Taoyuan, Taiwan
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Peng Y, Ji X, Zhang L, Tang P. Double locking plate fixation for femoral shaft nonunion. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:501-7. [DOI: 10.1007/s00590-016-1765-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 03/14/2016] [Indexed: 12/23/2022]
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Improve the Efficiency of Surgery for Femoral Shaft Fractures with A Novel Instrument: A Randomized Controlled Trial. PLoS One 2016; 11:e0154332. [PMID: 27115752 PMCID: PMC4846024 DOI: 10.1371/journal.pone.0154332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/11/2016] [Indexed: 11/20/2022] Open
Abstract
Objective To improve the efficacy of closed reduction and wire guiding during intramedullary nail internal fixation in femoral shaft fractures. Methods A novel instrument was designed and manufactured. Sixty-eight patients were enrolled from February 2011 to December 2013. The instrument designed was used during the operation in the experimental group, but not in the control group. Results All patients exhibited fracture union, excluding 1 patient in the experimental group and 2 in the control group who had non-union; all of whom achieved fracture union with reoperation. There were no statistically significant differences in operative blood loss or duration of hospital stay between the groups (P > 0.05). The operative time, frequency of wire drilling, and number of open reduction cases, were significantly smaller in the experimental group than in the control group (P < 0.05). Conclusion Femoral shaft fractures are difficult to reduce using general methods; the novel instrument showed high clinical value and proved effective and safe in assisting with closed reduction and intramedullary nail fixation for femoral shaft fractures. Trial Registration ChiCTR ChiCTR-ICR-15007335
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Lee JR, Kim HJ, Lee KB. Effects of third fragment size and displacement on non-union of femoral shaft fractures after locking for intramedullary nailing. Orthop Traumatol Surg Res 2016; 102:175-81. [PMID: 26826804 DOI: 10.1016/j.otsr.2015.11.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 11/06/2015] [Accepted: 11/13/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND The femoral shaft fractures with large fragments makes anatomical reduction challenging and often results in non-union. In some studies, the degree of fragment displacement was reported to have affected non-union, but the association between the one fragment size and degree of displacement has not been fully clarified. Therefore we performed a retrospective study to assess: (1) the more influential factor of non-union: the degree of fragment displacement, or the fragment size? (2) the non-union rates according to different sizes and degrees of displacement. HYPOTHESIS The degree of displacement is the more potent factor of non-union than the third fragment size in femoral shaft fractures. PATIENTS AND METHODS We assessed retrospectively 64 cases, which could be followed up for longer than one year. Fragments were divided according to the length of their long axis into three groups: group A (0-3.9cm), (n=21); group B (4-7.9cm), (n=22); group C (8cm or more), (n=21). Fragment displacement was also assessed in the proximal (P) or distal (D) end to the nearest cortex of the femoral shaft, and divided into the following groups: group P1 (n=44) or D1 (n=47), (0-9mm); group P2 (n=10) or D2 (n=11), (10-19mm); group P3 (n=7) or D3 (n=3), (20-29mm); and group P4 (n=3) or D4 (n=3), (30mm or more). RESULTS The bone union rate was 86% in the small (less than 8cm) fragment groups and 71% in the large (8cm or more) fragment group (P=0.046). With respect to the degree of displacement, the union rate was lower (P=0.001) and the average union time was longer (P=0.012) in the 20mm or more group for both the proximal fragment part and the distal fragment part (P=0.002, P=0.014). A logistic regression analysis underlined the displacement in the proximal site (OR: 0.298, 95% CI: 0.118-0.750) as in the distal site (OR: 0.359, 95% CI: 0.162-0.793) as a larger effect on union rate than the fragment size that as no effect in logistic regression (OR 3.8, 95% CI: 0.669-21.6). CONCLUSION Non-union develops significantly more frequently in femoral shaft fractures with fragments 8cm or longer or when the displacement in the proximal area is 20mm or greater and 10mm or greater in the distal area during the intramedullary nailing procedure. Regarding union rate, the degree of displacement has more influence than the third fragment size in femoral shaft fractures. LEVEL OF EVIDENCE IV, retrospective cohort study.
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Affiliation(s)
- J R Lee
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital Chonbuk National University Medical School, 634-18, Keum Am-dong, Dukjin-gu, Jeonju, Chonbuk, 561-712, Korea
| | - H-J Kim
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital Chonbuk National University Medical School, 634-18, Keum Am-dong, Dukjin-gu, Jeonju, Chonbuk, 561-712, Korea
| | - K-B Lee
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital Chonbuk National University Medical School, 634-18, Keum Am-dong, Dukjin-gu, Jeonju, Chonbuk, 561-712, Korea.
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Santolini E, West R, Giannoudis PV. Risk factors for long bone fracture non-union: a stratification approach based on the level of the existing scientific evidence. Injury 2015; 46 Suppl 8:S8-S19. [PMID: 26747924 DOI: 10.1016/s0020-1383(15)30049-8] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Non-union continues to be the most devastating complication after fracture fixation. Its treatment can be prolonged and often unpredictable. The burden to the patient, surgeon and health care system can be immense. Strategies to prevent it and or identify early its development are desirable in order to improve the clinical course of the affected patients and their outcomes. We undertook a systematic review of the literature in order to identify the most common and important risk factors based on the hierarchy of level of evidence. Accordingly, a stratification scale was formed which highlighted 10 risk factors including; an open method of fracture reduction, open fracture, presence of post-surgical fracture gap, smoking, infection, wedge or comminuted types of fracture, high degree of initial fracture displacement, lack of adequate mechanical stability provided by the implant used, fracture location in the poor zone of vascularity of the affected bone, and the presence of the fracture in the tibia. Clinicians should take in to account these findings when managing patients with long bone fractures, particularly the femur and tibia in order to minimise the risk of non-union.
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Affiliation(s)
- Emmanuele Santolini
- Academic Department of Trauma and Orthopaedics, Floor A, Clarendon Wing, LGI, University of Leeds, Leeds, UK; Clinica Orthopedica, University of Genoa, IRCCS A.O.U. San Martino - IST, Largo R. Benzi 10 - 16132, Genova, Italy
| | - Robert West
- Academic Department of Statistics, University of Leeds, Leeds, UK
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, Floor A, Clarendon Wing, LGI, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.
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Hoyt BW, Pavey GJ, Pasquina PF, Potter BK. Rehabilitation of Lower Extremity Trauma: a Review of Principles and Military Perspective on Future Directions. CURRENT TRAUMA REPORTS 2015. [DOI: 10.1007/s40719-014-0004-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Liu Y, Li H, Zhang Y. To "effect of fragmentary displacement and morphology in the treatment of comminuted femoral shaft fractures with an intramedullary nail". Injury 2014; 45:2115-6. [PMID: 24994034 DOI: 10.1016/j.injury.2014.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 05/18/2014] [Indexed: 02/02/2023]
Affiliation(s)
- Yueju Liu
- Third Hospital of Hebei Medical University, Shijiazhuang 050051, PR China; Key Orthopaedic Biomechanics Laboratory of Hebei Province, Shijiazhuang, PR China.
| | - Han Li
- Third Hospital of Hebei Medical University, Shijiazhuang 050051, PR China; Key Orthopaedic Biomechanics Laboratory of Hebei Province, Shijiazhuang, PR China.
| | - Yingze Zhang
- Third Hospital of Hebei Medical University, Shijiazhuang 050051, PR China; Key Orthopaedic Biomechanics Laboratory of Hebei Province, Shijiazhuang, PR China.
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