Are the unreamed nails indicated in diaphyseal fractures of the lower extremity? A biomechanical study

Effectiveness and safety of augmentative plating technique in managing nonunion following intramedullary nailing of long bones in the lower extremity: A systematic review and meta-analysis

PURPOSE

To methodically assess the effectiveness of augmentative plating (AP) and exchange nailing (EN) in managing nonunion following intramedullary nailing for long bone fractures of the lower extremity.

METHODS

PubMed, EMBASE, Web of Science, and the Cochrane Library were searched to gather clinical studies regarding the use of AP and EN techniques in the treatment of nonunion following intramedullary nailing of lower extremity long bones. The search was conducted up until May 2023. The original studies underwent an independent assessment of their quality, a process conducted utilizing the Newcastle-Ottawa scale. Data were retrieved from these studies, and meta-analysis was executed utilizing Review Manager 5.3.

RESULTS

This meta-analysis included 8 studies involving 661 participants, with 305 in the AP group and 356 in the EN group. The results of the meta-analysis demonstrated that the AP group exhibited a higher rate of union (odds ratio: 8.61, 95% confidence intervals (CI): 4.12 - 17.99, p < 0.001), shorter union time (standardized mean difference (SMD): -1.08, 95 % CI: -1.79 - -0.37, p = 0.003), reduced duration of the surgical procedure (SMD: -0.56, 95 % CI: -0.93 - -0.19, p = 0.003), less bleeding (SMD: -1.5, 95 % CI: -2.81 - -0.18), p = 0.03), and a lower incidence of complications (relative risk: -0.17, 95 % CI: -0.27 - -0.06, p = 0.001). In the subgroup analysis, the time for union in the AP group in nonisthmal and isthmal nonunion of lower extremity long bones was shorter compared to the EN group (nonisthmal SMD: -1.94, 95 % CI: -3.28 - -0.61, p < 0.001; isthmal SMD: -1.08, 95 % CI: -1.64 - -0.52, p = 0.002).

CONCLUSION

In the treatment of nonunion in diaphyseal fractures of the long bones in the lower extremity, the AP approach is superior to EN, both intraoperatively (with reduced duration of the surgical procedure and diminished blood loss) and postoperatively (with an elevated union rate, shorter union time, and lower incidence of complications). Specifically, in the management of nonunion of lower extremity long bones with non-isthmal and isthmal intramedullary nails, AP demonstrated shorter union time in comparison to EN.

Application of bridge-link type combined fixation system in the treatment of trifocal femoral fractures

PURPOSE

Ipsilateral combined fractures of the proximal femur, femoral shaft, and distal femur, though uncommon, present significant treatment challenges for orthopaedic surgeons. This retrospective study aims to investigate the intraoperative and long-term postoperative outcomes of this combination fracture when treated using a bridge-link type combined fixation system (BCFS).

PATIENTS AND METHODS

Four individuals received treatment at a level 1 trauma centre between January 2013 and December 2017 for combined fractures of the proximal femur, femoral shaft, and distal femur. The medical records of these patients were retrospectively examined. In addition to minimally invasive percutaneous plate osteosynthesis (MIO), all patients underwent BCFS.

RESULTS

The median follow-up period for each patient was 28.5 months. The median duration of the surgical procedure was 176.0 min, with intraoperative haemorrhage measured at 470.0 ml. Among the cases, three patients showed firm union of the femoral shaft fractures. However, one patient experienced nonunion 12 months after the procedure, while another patient suffered from refracture of the femoral shaft and postoperative avascular necrosis of the femoral head. At the time of the last follow-up, the Friedman-Wyman functional scores were excellent in one case, good in two cases, and fair in one case.

CONCLUSIONS

Trifocal femoral fractures lack a widely approved therapeutic strategy. Nonetheless, BCFS may present itself as a viable alternative for treating this type of fracture, offering positive clinical outcomes.

The Efficacy of Rehabilitation Nursing Interventions on Patients with Open Lower Limb Fractures

Objective

The study aims to analyze the efficacy of rehabilitation nursing interventions on patients with open lower limb fractures.

Methods

From June 2020, patients who received RNI (observation group) were included and compared with patients who received routine nursing interventions (control group). The efficacy of different nursing modes was compared with several indicators.

Results

One hundred patients were included in this study, 50 in each group. The baseline characteristics were not significantly different between the groups. Regarding the emotional scores, the Self-Rating Anxiety Scale (SAS) score (26.98 vs 43.47), and Distress Management Screening Measure (DMSM) score (8.01 vs 12.85) in the observation group were significantly lower than those in the control group, both P < 0.05. Regarding the postoperative related indexes, the postoperative pain score (10.13 vs 15.53), fracture healing time (6.32 vs 10.86 weeks), and postoperative complications rate (0 vs 12%) in the observation group were all significantly lower than those in the control group, all P < 0.05. Regarding the quality of life scores, the WHOQOL-100 score (94.12 vs 83.13) and PSQI score (6.43 vs 10.36) were both significantly better in the observation group, with both P < 0.05.

Conclusion

Patients with open lower limbs who received RNI can help patients reduce postoperative anxiety and stress, promote postoperative rehabilitation and improve their quality of life.