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Olasinde AA, Olisa O, Muhumuza J, Oluwadiya KS. Early outcome measurement of the effectiveness of conventional physical therapy versus continuous passive motion in knee function following retrograde femoral nailing-a prospective randomized controlled trial. INTERNATIONAL ORTHOPAEDICS 2023; 47:2085-2093. [PMID: 37269402 DOI: 10.1007/s00264-023-05854-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/23/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE This study evaluated the efficacy of continuous passive motion (CPM) versus conventional physical therapy (CPT) in the early postoperative period following retrograde femoral nailing (RFILN). Based on the principles of operation of CPM, we hypothesized that it would improve knee function and decrease pain after open reduction and internal fixation with a retrograde femoral interlocking nail. PATIENTS AND METHODS Eighty-eight patients over the age of 18 years who met the inclusion criteria got randomized into one of two groups. The experimental group had CPM, while the control group had CPT. Postoperative knee functions assessed were the degree of knee stiffness, the total arc of motion, and knee pain. Knee stiffness, defined as the range of motion ≤ 90° assessed one week, two weeks, and six weeks postoperatively, while knee pain was measured using the visual analog scale (VAS) on days one, two, three, four, five, six and seven postoperatively. RESULTS The CPM group had a significantly lower incidence of knee stiffness at one week, two weeks, and six weeks postoperatively than the CPT group (all p < 0.0001). The VAS scores of the CPM group on days one, two, three, four, five, six and seven were significantly lower than those of the CPT group (p < 0.006 for day one and p < 0.001 for the remaining days). Similarly, the total arc of motion gained postoperatively was significantly greater in the CPM group than in the CPT (all p < 0.001). CONCLUSION The continuous passive motion effectively reduced the number of patients with knee stiffness and knee pain. It increased the total arc of motion in the early postoperative period compared to CPT. Therefore, we recommend CPM for patients undergoing retrograde femoral nailing use in the early postoperative period.
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Affiliation(s)
- Anthony Ayotunde Olasinde
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University (Western Campus), Ishaka-, Bushenyi, Uganda.
- Department of Orthopaedic Surgery, Federal Medical Centre, Owo, Ondo State, Nigeria.
| | - Olusegun Olisa
- Department of Orthopaedic Surgery, Federal Medical Centre, Owo, Ondo State, Nigeria
| | - Joshua Muhumuza
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University (Western Campus), Ishaka-, Bushenyi, Uganda
| | - Kehinde Sunday Oluwadiya
- Department of Surgery, College of Medicine, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
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Bailey RS, Nwadike BA, Revak T. A retrospective review of the rate of septic knee arthritis after retrograde femoral nailing for traumatic femoral fractures at a single academic institution. OTA Int 2023; 6:e264. [PMID: 37780183 PMCID: PMC10538562 DOI: 10.1097/oi9.0000000000000264] [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: 06/22/2022] [Accepted: 01/07/2023] [Indexed: 10/03/2023]
Abstract
Background Retrograde intramedullary nailing of the femur is a popular treatment option for femoral shaft fractures. However, this requires accessing the intramedullary canal through the knee, posing a risk of intra-articular infection. The purpose of this study was to examine the rate of intra-articular infection of the knee after retrograde nailing of femoral shaft fractures. Methods All patients who underwent retrograde intramedullary nailing for femoral shaft fractures between June 2004 and December 2017 at a level 1 trauma center were reviewed. Six months of follow-up or documented fracture union was required. Records were reviewed for documentation of septic arthritis of the ipsilateral knee during the follow-up period. Results A total of 294 fractures, including 217 closed and 77 open injuries, were included. Eighteen had an associated ipsilateral traumatic arthrotomy; 188 cases had an associated ipsilateral lower extremity fracture. No cases of septic arthritis were identified. Conclusion There were no cases of septic arthritis in 294 fractures treated with retrograde intramedullary nailing. Retrograde nailing appears safe for risk of postoperative septic arthritis of the knee even in the face of open fractures and traumatic wounds.
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Affiliation(s)
- Ryan S. Bailey
- Department of Orthopaedic Surgery, Saint Louis University, School of Medicine, St. Louis, MO
| | - Benjamin A. Nwadike
- Department of Orthopaedic Surgery, Saint Louis University, School of Medicine, St. Louis, MO
| | - Thomas Revak
- Department of Orthopaedic Surgery, Saint Louis University, School of Medicine, St. Louis, MO
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Adesina SA, Amole IO, Oyewusi OO, Adefokun IG, Odekhiran EO, Adeniji DO, Adegoke AO, Ojo SA, Owolabi JI, Eyesan SU. Locked intramedullary nailing of diaphyseal femur fractures without intraoperative fluoroscopy, fracture table and power reaming: retrograde affords greater procedural efficiency than antegrade approach. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05832-8. [PMID: 37140596 DOI: 10.1007/s00264-023-05832-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 04/28/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE To compare the intraoperative procedural efficiency of antegrade and retrograde locked intramedullary nailing of diaphyseal femur fractures without intraoperative fluoroscopy, power reaming devices and fracture tables. METHODS A secondary analysis of prospectively collected data was conducted on 238 isolated diaphyseal femur fractures fixed with SIGN Standard and Fin nails within three weeks of injury. The data included baseline patient and fracture characteristics, nail type and diameter, fracture reduction methods, operative times and outcome measures. RESULTS There were 84 and 154 fractures in the antegrade and retrograde groups respectively. Both groups were similar vis-a-vis baseline patient and fracture characteristics. Closed reduction of the fractures was significantly easier for retrograde than an antegrade approach. The retrograde approach more readily permitted the use of Fin nails. The mean nail diameter used for retrograde was significantly larger than that for antegrade. The time taken to achieve retrograde nailing was significantly lesser than that of antegrade. There was no statistically significant difference between the outcomes of the two groups. CONCLUSION In the absence of expensive fracture-surgery gadgets, retrograde nailing offers many procedural advantages over antegrade, such as easier closed reduction and canal reaming, the greater possibility of using the Fin nail with fewer interlocking screws and shorter operative times. However, we acknowledge the lack of randomisation and the presence of an unequal number of fractures in the two groups as limitations of this study.
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Affiliation(s)
- Stephen Adesope Adesina
- Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria.
- Bowen University, P.M.B 284, Iwo, Osun State, Nigeria.
| | - Isaac Olusayo Amole
- Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria
- Bowen University, P.M.B 284, Iwo, Osun State, Nigeria
| | | | | | | | | | - Adepeju Olatayo Adegoke
- Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria
- Bowen University, P.M.B 284, Iwo, Osun State, Nigeria
| | - Simeon Ayorinde Ojo
- Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria
- Bowen University, P.M.B 284, Iwo, Osun State, Nigeria
| | - James Idowu Owolabi
- Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria
- Bowen University, P.M.B 284, Iwo, Osun State, Nigeria
| | - Samuel Uwale Eyesan
- Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria
- Bowen University, P.M.B 284, Iwo, Osun State, Nigeria
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Baker HP, Krishnan P, Foy M, Strelzow J, Daccarett M, Dillman D. Effect of nailing technique on length of stay in isolated ballistic femoral shaft fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:353-360. [PMID: 35088146 DOI: 10.1007/s00590-021-03191-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/16/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to investigate length of stay, postoperative mobilization and discharge disposition following intramedullary nailing of ballistic femoral shaft fractures stratified by nailing technique. METHODS All adult patients with isolated ballistic femoral shaft fractures between May 1, 2018, and September 1, 2021, were reviewed. The final cohort included 69 ballistic femur fractures in 69 patients. Of the 69 patients included, 29 were treated with retrograde nailing while 40 were treated with antegrade nailing. RESULTS The average length of stay of patients treated with antegrade nailing was 2.55 days (SD 1.3 days) compared with 3.45 days (SD 2.3 days) for patients treated with retrograde nailing; this was statistically significant (P = 0.04). Median steps on POD1 for antegrade nailing were 20 and 8 for retrograde. There was no significant difference in VAS pain scores between the two cohorts. All patients were discharged home. CONCLUSION The average length of stay for patients who underwent antegrade nailing was significantly shorter when compared with the retrograde nailing. Patients in the antegrade cohort mobilized further than the retrograde cohort in the immediate postoperative setting. We found no significant difference in VAS pain scores between the two cohorts. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Hayden P Baker
- Department of Orthopaedic Surgery, The University of Chicago, 5758 S. Maryland Avenue, Dept 4B, Chicago, IL, 60637, USA.
| | - Pranav Krishnan
- Department of Orthopaedic Surgery, The University of Chicago, 5758 S. Maryland Avenue, Dept 4B, Chicago, IL, 60637, USA
| | - Michael Foy
- Department of Orthopaedic Surgery, The University of Chicago, 5758 S. Maryland Avenue, Dept 4B, Chicago, IL, 60637, USA
| | - Jason Strelzow
- Department of Orthopaedic Surgery, The University of Chicago, 5758 S. Maryland Avenue, Dept 4B, Chicago, IL, 60637, USA
| | - Miguel Daccarett
- Department of Orthopaedic Surgery, The University of Chicago, 5758 S. Maryland Avenue, Dept 4B, Chicago, IL, 60637, USA
| | - Daryl Dillman
- Department of Orthopaedic Surgery, The University of Chicago, 5758 S. Maryland Avenue, Dept 4B, Chicago, IL, 60637, USA
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Muacevic A, Adler JR, Liu JN, Ponce BA, Phipatanakul WP. Percutaneous Intramedullary Nailing of Complex Humeral Shaft Fractures: A Retrospective Case Series. Cureus 2022; 14:e32999. [PMID: 36712726 PMCID: PMC9879284 DOI: 10.7759/cureus.32999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Humeral diaphyseal fractures have been traditionally stabilized with plates and screws. However, surgical morbidity can be quite extensive, particularly in more complex segmental and comminuted fracture patterns. An intramedullary nail (IMN) has the biomechanical advantage of being a load-sharing device and can be placed with a more minimally invasive technique. The purpose of this study was to evaluate the clinical and radiographic outcomes of complex humeral shaft fractures treated with an IMN utilizing a percutaneous surgical technique. METHODS A retrospective review was performed on a consecutive series of patients who underwent treatment of a complex humeral shaft fracture with an IMN placed with a percutaneous technique. Clinical outcome scores and radiographic analysis were performed at a minimum one-year follow-up. RESULTS Of the 14 patients included, 12 had clinical and radiographic follow-ups at one year. The majority (64%) were obese and involved polytrauma (50%), and 79% were AO Foundation/Orthopaedic Trauma Association (AO/OTA) type C fractures. Union after the index procedure was 93%, with one nonunion requiring a secondary operation. The average operative time was 103 minutes. There were no other complications or additional procedures. The mean clinical outcome scores included American Shoulder and Elbow Society (ASES): 78.2, Constant Score: 72.1, Single Assessment Numerical Evaluation (SANE): 81.9, and Penn Shoulder Score: 82.7. CONCLUSION This study demonstrates complex comminuted and segmental humeral shaft fractures in a higher-risk patient population can be effectively managed with IMN. Percutaneous placement of an IMN should be considered as a treatment option in complex humeral shaft fractures, particularly in patients with secondary comorbidities such as obesity and polytrauma.
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Retrospective Comparison of Postoperative Fascia Iliaca Block and Multimodal Drug Injection on Early Function of the Knee in Femoral Fractures Using Retrograde Intramedullary Nailing. Pain Res Manag 2022; 2022:7027637. [PMID: 35345624 PMCID: PMC8957458 DOI: 10.1155/2022/7027637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/28/2022] [Indexed: 11/18/2022]
Abstract
Introduction There is a common concern about the pain and rehabilitation of the knee after femoral retrograde intramedullary nailing. It is essential for early postoperative knee function required for physical self-maintenance in daily life. And a favorable rehabilitation of the knee usually promotes the quality of life. However, early rehabilitation is absent or insufficient for many patients in postoperative management. This retrospective study aims to evaluate the effect of early knee function improvement in comparison to postoperative fascia iliaca blocking (FIB) and multimodal drug injection (MDI). Patients and Methods. A retrospective analysis of 41 patients receiving femoral fracture treatment with retrograde intramedullary nailing, was performed during 2018–2020. 19 patients were treated with MDI as postoperative analgesia, and 22 patients were treated with FIB. Rehabilitation started on the first postoperative day and lasted for 3 months. Visual analog scale (VAS), the range of motion (ROM) of the knee, and single assessment numeric evaluation (SANE) were assessed. Results There was no significant difference shown in any of the demographic, fracture types, and operative time. All patients performed regular and voluntary knee rehabilitation and weight-bearing at home following the instruction from the orthopedic staff. Pain in the FIB group at postoperative 1-day was milder (1.7 ± 1.1), compared with that in the MDI group (2.8 ± 1.3, p=0.038). There was a significant difference in VAS between two groups at postoperative 1-month (p=0.031), with a peak score in the FIB group (3.3 ± 0.9). At postoperative 3-month, both groups had pain relief with similar VAS (p=0.465). The ROM of the knee in both groups was continuously improved during the first three months. The SANE in the MDI group was significantly different compared with FIB at 1-month (p=0.026). However, scores of SANE were similar in both groups at 3 months (p=0.541). All patients were identified as fractures union at 9-month or 12-month follow-up. Conclusion The knee pain was commonly experienced in this series of retrograde femoral nailings. Both MDI and FIB provided immediate and effective pain control after femoral fracture surgery. MDI was more beneficial to continuous pain control and knee rehabilitation in the early follow-up. The extent of pain relief and knee function improvement reached the same level at postoperative 3-month.
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Brewster J, Grenier G, Taylor BC, Carter C, Degenova D, Ebaugh MP, Halverson A. Long-term Comparison of Retrograde and Antegrade Femoral Nailing. Orthopedics 2020; 43:e278-e282. [PMID: 32324245 DOI: 10.3928/01477447-20200415-04] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/26/2019] [Indexed: 02/03/2023]
Abstract
Antegrade or retrograde nailing for femoral shaft fractures remains the gold standard, but long-term data on functional outcomes after intramedullary nailing are lacking. In a retrospective review of prospectively collected patient registry data, patients with an isolated femoral shaft fracture treated with antegrade or retrograde femoral nailing from 1997 to 2012 were interviewed and their medical records analyzed. Functional reported outcome data were obtained via the visual analog scale (VAS) for pain and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 5 to 17 years postoperatively. Antegrade and retrograde intramedullary nailing of diaphyseal femur shaft fractures demonstrated a mean WOMAC of 23.5%±23.6% (range, 0%-82.3%) and 29.7%±24.0% (range, 0%-88%), respectively (P=.23). The mean VAS scores of the antegrade vs retrograde intramedullary nailing groups were 2.5±2.6 (range, 0-8) and 3.4±2.8 (range, 0-10), respectively (P=.11). Location of pain differed between groups as well, with the antegrade group noting an increased rate of hip pain (25.6% vs 7.0%, P=.01), but a nonsignificant difference in the rate of thigh pain (27.9% vs 15.5%, P=.15) and knee pain (18.6% vs 26.7%, P=.49) as compared with the retrograde group. Diaphyseal femur fractures are successfully treated with either antegrade or retrograde intramedullary nails without significantly differing long-term functional outcomes, which correlates with other reported findings in the literature at short-term follow-up. [Orthopedics. 2020;43(4):e278-e282.].
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Kim JW, Oh CW, Oh JK, Park KH, Kim HJ, Kim TS, Seo I, Park EK. Treatment of infra-isthmal femoral fracture with an intramedullary nail: Is retrograde nailing a better option than antegrade nailing? Arch Orthop Trauma Surg 2018; 138:1241-1247. [PMID: 29799078 DOI: 10.1007/s00402-018-2961-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Antegrade intramedullary (IM) nailing is ideal for femoral shaft fractures, but fixing the fracture distal to the isthmal level may be difficult because of medullary canal widening and the proximity of fracture location from the distal femoral joint line. This study aimed to compare treatment results between antegrade and retrograde nailing for infra-isthmal femoral shaft fracture, and to identify influencing factors of nonunion and malalignment. MATERIALS AND METHODS Sixty patients with infra-isthmal femoral shaft fractures treated with IM nailing and followed-up for > 1 year were enrolled in this retrospective study, 38 in the antegrade nailing group, and 22 in the retrograde nailing group. The two groups had no significant differences in age, sex, and fracture location (p = 0.297, Mann-Whitney test). Radiological evaluation was performed, and functional result was assessed using the Knee Society scoring system. Complications were analyzed in accordance with fracture location, fracture type, and operative method. RESULTS According to the AO/OTA classification, 35, 16, and 9 cases were type A (A1: 1, A2: 11, A3: 23), B (B1: 2, B2: 7, B3: 7), and C fractures (C2: 4, C3: 5), respectively. The mean follow-up duration was 29.5 months. In the antegrade and retrograde nailing groups, the primary bony union rates were 73.7% in 20.7 weeks (range 12-41) and 86.4% in 17.4 weeks (range 12-30), respectively. The two groups showed no significant differences in union rate (p = 0.251, Pearson's Chi-square test) and union time (p = 0.897, Mann-Whitney test). No cases of malalignment of > 10° in any plane were found in both groups. The mean Knee Society scores were 92 (range 84-100) and 91 (range 83-95) in the antegrade and retrograde nailing groups, respectively, showing no significant difference (p = 0.297, Pearson's Chi-square test). Although fracture location was not significantly related to union rate (p = 0.584, Mann-Whitney test), patients with an effective working length of the distal segment of < 0.75 were prone to nonunion (p = 0.003, Pearson's Chi-square test). CONCLUSIONS Although no significant difference was found in IM nail type, the IM nail with a shorter working length distal to the fracture showed a strong relationship with nonunion.
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Affiliation(s)
- Joon-Woo Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu, 41944, South Korea
| | - Chang-Wug Oh
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu, 41944, South Korea.
| | - Jong-Keon Oh
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Kyeong-Hyeon Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu, 41944, South Korea
| | - Hee-June Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu, 41944, South Korea
| | - Tae-Seong Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu, 41944, South Korea
| | - Il Seo
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu, 41944, South Korea
| | - Eung-Kyoo Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu, 41944, South Korea
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The Resolution Axis Method (RAM) for lengthening of the femur with or without associated frontal plane deformity (a new method). Strategies Trauma Limb Reconstr 2018; 13:109-118. [PMID: 29797157 PMCID: PMC6042223 DOI: 10.1007/s11751-018-0312-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 05/20/2018] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Femoral lengthening with or along intramedullary (IM) nails will occur along the axis of the nail coincident with the anatomical axis of the bone. In the femur particularly, such lengthening often creates lateral mechanical axis deviation as the knee is driven medially. In cases where shortening is associated with frontal plane deformity the surgeon needs to correct the deformity intra-operatively, however, subsequent lengthening along the anatomical axis will create deformity. Thus, planning for lengthening of the femur with or along IM nails, whether shortening is associated with frontal plane deformity or not, requires a completely different planning strategy. The author questioned if a resolution anatomical axis can be identified and used for planning when lengthening the femur along or with IM nails while still applying the same classic CORA deformity analysis method. METHODS In a prospective study, the author included eight patients who needed femoral lengthening, five with associated frontal plane deformity and three without. The author identified a method to determine the trajectory of the nail in the lower femoral segment. It was done by calculating the angle enclosed between this resolution anatomical axis and the mechanical axis, also known as the anatomical-mechanical angle. RESULTS This new method has proven to be effective in achieving normal alignment after lengthening is completed. CONCLUSION The Resolution Axis Method is a new and alternative method providing a solution for planning when lengthening the femur along the anatomical axis using an IM nail, whether a deformity is present or not.
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Andrade-Silva FB, Carvalho A, Mansano C, Giese A, de Camargo Leonhardt M, Barbosa D, Kojima KE, Silva JS. Functional results and isokinetic muscle strength in patients with Fraser type I floating knee treated with internal fixation. Injury 2017; 48 Suppl 4:S2-S5. [PMID: 29145963 DOI: 10.1016/s0020-1383(17)30767-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION According to Fraser's description, ipsilateral femoral and tibial diaphyseal fractures are characterised as type I floating knee and have a better prognosis than fractures with joint involvement (type II). There are few reports of functional and muscle strength in these patients. The objective of this study was to evaluate the functional and isokinetic muscle strength of patients with type I floating knee undergoing femoral and tibial internal fixation. METHODS Patients with type I floating knee undergoing concomitant femoral and tibial internal fixation were invited for clinical evaluation. The parameters evaluated included the following: Karlstrom and Olerud score; Lysholm score; isokinetic thigh and hip muscle evaluation; knee range of motion; pain level; investigation of associated knee injuries by clinical evaluation and MRI; and types of complications. RESULTS Twenty-one patients were included in the study; 11 of these were clinically evaluated, with a mean follow-up of 23.9 months. Six patients had an acceptable result according to the Karlstrom criteria, whereas eight patients had a poor result based on the Lysholm scale. The peak torque deficit was 61% for knee extensors, 37% for flexors and -9% for hip abductors. The mean pain level was 5.9. Three patients had a partial anterior cruciate ligament (ACL) injury; one patient had a posterior cruciate ligament (PCL) injury; and three patients had a meniscal injury. There were four cases of tibial or femoral nonunion at one year and two cases of chronic osteomyelitis. CONCLUSION Patients with type I floating knee had unsatisfactory functional results, significant knee extensor and flexor muscle strength deficits and a significant rate of complications at the two-year follow-up.
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Affiliation(s)
| | - Adriana Carvalho
- Department of Orthopedics and Traumatology, University of Sao Paulo, Brazil
| | - Caio Mansano
- Department of Orthopedics and Traumatology, University of Sao Paulo, Brazil
| | - Aline Giese
- Department of Orthopedics and Traumatology, University of Sao Paulo, Brazil
| | | | - Dennis Barbosa
- Department of Orthopedics and Traumatology, University of Sao Paulo, Brazil
| | - Kodi Edson Kojima
- Department of Orthopedics and Traumatology, University of Sao Paulo, Brazil
| | - Jorge Santos Silva
- Department of Orthopedics and Traumatology, University of Sao Paulo, Brazil
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Hussain N, Hussain FN, Sermer C, Kamdar H, Schemitsch EH, Sternheim A, Kuzyk P. Antegrade versus retrograde nailing techniques and trochanteric versus piriformis intramedullary nailing entry points for femoral shaft fractures: a systematic review and meta-analysis. Can J Surg 2017; 60:19-29. [PMID: 28234586 DOI: 10.1503/cjs.000616] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND There are several different techniques commonly used to perform intramedullary (IM) nailing of the femur to fix femoral fractures. We sought to identify significant differences in outcomes of studies comparing 1) trochanteric and piriformis entry and 2) antegrade and retrograde entry in IM nailing of the femur. METHODS We searched MEDLINE, Cochrane and Embase databases and the Orthopaedic Trauma Association and American Academy of Orthopaedic Surgeons websites for comparative studies published from inception to November 2015. Criteria used to select articles for detailed review included use of antegrade and retrograde entry point or use of trochanteric and piriformis entry point for IM nailing of the femur in adult patients. Functional and technical outcomes were extracted from accepted studies. RESULTS We identified 483 potential studies, of which 52 were eligible. Of these, we included 13 publications and 2 abstracts (2 level I, 7 level II and 6 level III studies). Trochanteric entry significantly reduced operative duration by 14 min compared with piriformis entry (p = 0.030). Retrograde nailing had a greater risk of postoperative knee pain than antegrade nailing (p = 0.05). On the other hand, antegrade nailing had significantly more postoperative hip pain (p = 0.003) and heterotopic ossification (p < 0.001) than retrograde nailing. No significant differences in functional outcomes were observed. CONCLUSION Although some significant differences were found, the varying quality of studies made recommendation difficult. Our meta-analysis did not confirm superiority of either antegrade over retrograde or trochanteric over piriformis entry for IM nailing of the femur. LEVEL OF EVIDENCE Level III therapeutic.
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Affiliation(s)
- Nasir Hussain
- From the Department of Orthopaedics, St. Michael's Hospital, University of Toronto, Toronto, Ont. (Hussain, Naz Hussain, Schemitsch); the Wayne State University School of Medicine, Detroit, Michigan (Naz Hussain); the Division of Orthopaedic Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Sermer, Sternheim, Kuzyk); and the Dow University of Health Sciences, Karachi, Pakistan (Kamdar)
| | - Farrah Naz Hussain
- From the Department of Orthopaedics, St. Michael's Hospital, University of Toronto, Toronto, Ont. (Hussain, Naz Hussain, Schemitsch); the Wayne State University School of Medicine, Detroit, Michigan (Naz Hussain); the Division of Orthopaedic Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Sermer, Sternheim, Kuzyk); and the Dow University of Health Sciences, Karachi, Pakistan (Kamdar)
| | - Corey Sermer
- From the Department of Orthopaedics, St. Michael's Hospital, University of Toronto, Toronto, Ont. (Hussain, Naz Hussain, Schemitsch); the Wayne State University School of Medicine, Detroit, Michigan (Naz Hussain); the Division of Orthopaedic Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Sermer, Sternheim, Kuzyk); and the Dow University of Health Sciences, Karachi, Pakistan (Kamdar)
| | - Hera Kamdar
- From the Department of Orthopaedics, St. Michael's Hospital, University of Toronto, Toronto, Ont. (Hussain, Naz Hussain, Schemitsch); the Wayne State University School of Medicine, Detroit, Michigan (Naz Hussain); the Division of Orthopaedic Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Sermer, Sternheim, Kuzyk); and the Dow University of Health Sciences, Karachi, Pakistan (Kamdar)
| | - Emil H Schemitsch
- From the Department of Orthopaedics, St. Michael's Hospital, University of Toronto, Toronto, Ont. (Hussain, Naz Hussain, Schemitsch); the Wayne State University School of Medicine, Detroit, Michigan (Naz Hussain); the Division of Orthopaedic Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Sermer, Sternheim, Kuzyk); and the Dow University of Health Sciences, Karachi, Pakistan (Kamdar)
| | - Amir Sternheim
- From the Department of Orthopaedics, St. Michael's Hospital, University of Toronto, Toronto, Ont. (Hussain, Naz Hussain, Schemitsch); the Wayne State University School of Medicine, Detroit, Michigan (Naz Hussain); the Division of Orthopaedic Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Sermer, Sternheim, Kuzyk); and the Dow University of Health Sciences, Karachi, Pakistan (Kamdar)
| | - Paul Kuzyk
- From the Department of Orthopaedics, St. Michael's Hospital, University of Toronto, Toronto, Ont. (Hussain, Naz Hussain, Schemitsch); the Wayne State University School of Medicine, Detroit, Michigan (Naz Hussain); the Division of Orthopaedic Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Sermer, Sternheim, Kuzyk); and the Dow University of Health Sciences, Karachi, Pakistan (Kamdar)
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Sikka R, Fetzer G, Hunkele T, Sugarman E, Boyd J. Femur fractures in professional athletes: a case series. J Athl Train 2015; 50:442-8. [PMID: 25680071 DOI: 10.4085/1062-6050-49.5.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To discuss return to play after femur fractures in several professional athletes. BACKGROUND Femur fractures are rare injuries and can be associated with significant morbidity and mortality. No reports exist, to our knowledge, on return to play after treatment of isolated femur fractures in professional athletes. Return to play is expected in patients with femur fractures, but recovery can take more than 1 year, with an expected decrease in performance. TREATMENT Four professional athletes sustained isolated femur fractures during regular-season games. Two athletes played hockey, 1 played football, and 1 played baseball. Three players were treated with anterograde intramedullary nails, and 1 was treated with retrograde nailing. All players missed the remainder of the season. At an average of 9.5 months (range, 7-13 months) from the time of injury, all athletes were able to return to play. One player required the removal of painful hardware, which delayed his return to sport. Final radiographs revealed that all fractures were well healed. No athletes had subjective complaints or concerns that performance was affected by the injury at an average final follow-up of 25 months (range, 22-29 months). UNIQUENESS As the size and speed of players increase, on-field trauma may result in significant injury. All players returned to previous levels of performance or exceeded previous statistical performance levels. CONCLUSIONS In professional athletes, return to play from isolated femur fractures treated with either an anterograde or retrograde intramedullary nail is possible within 1 year. Return to the previous level of performance is possible, and it is important to develop management protocols, including rehabilitation guidelines, for such injuries. However, return to play may be delayed by subsequent procedures, including hardware removal.
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A prospective study of pain reduction and knee dysfunction comparing femoral skeletal traction and splinting in adult trauma patients. J Orthop Trauma 2015; 29:112-8. [PMID: 25050750 PMCID: PMC4302053 DOI: 10.1097/bot.0000000000000202] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine if distal femoral traction pins result in knee dysfunction in patients with femoral or pelvic fracture, and to determine if skeletal traction relieves pain more effectively than splinting for femoral shaft fractures. DESIGN Prospective cohort trial. SETTING Level I urban trauma center. PATIENTS/PARTICIPANTS One hundred twenty adult patients with femoral shaft, acetabular, and unstable pelvic fractures. INTERVENTION Patients with femoral shaft fractures were placed into distal femoral skeletal traction or a long-leg splint, based on an attending-specific protocol. Patients with pelvic or acetabular fractures with instability or intraarticular bone fragments were placed into skeletal traction. MAIN OUTCOME MEASUREMENTS An initial Lysholm knee survey was administered to assess preinjury knee pain and function; the survey was repeated at 3- and 6-month follow-up visits. Also, a 10-point visual analog scale was used to document pain immediately before, during, and immediately after fracture immobilization with traction or splinting. RESULTS Thirty-five patients (29%) were immobilized with a long-leg splint, and 85 (71%) were immobilized with a distal femoral traction pin. Eighty-four patients (70%) completed a 6-month follow-up. Lysholm scores decreased by a mean 9.3 points from preinjury baseline to 6 months postinjury in the entire cohort (P < 0.01); no significant differences were found between the splint and traction pin groups. During application of immobilization, visual analog scale pain scores were significantly lower in traction patients as compared with splinted patients (mean, 1.9 points less, P < 0.01). Traction pins caused no infections, neurovascular injuries, or iatrogenic fractures. CONCLUSIONS Distal femoral skeletal traction does not result in detectable knee dysfunction at 6 months after insertion, and results in less pain during and after immobilization than long-leg splinting. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Küçükkaya M, Karakoyun Ö, Sökücü S, Soydan R. Femoral lengthening and deformity correction using the Fitbone motorized lengthening nail. J Orthop Sci 2015; 20:149-54. [PMID: 25326815 PMCID: PMC4302230 DOI: 10.1007/s00776-014-0659-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 09/26/2014] [Indexed: 12/05/2022]
Abstract
BACKGROUND This study reports our results with retrograde Fitbone insertion in patients with femoral shortening and deformity. We also present our experience regarding the benefits, complications, and factors associated with complications of the Fitbone technique. METHODS Twelve males and ten females had femoral shortening and deformities treated using the retrograde Fitbone technique between 2009 and 2012. The etiologies were post-traumatic in 12 patients, poliomyelitis in four, cosmetic in two, congenital hypoplasia in two, achondroplasia in one, and Perthes sequela in one. RESULTS The follow-up time was 30.8 months. The mean lengthening was 5.8 (range 2-14) cm. The degree of acute angular correction was 9° (5-22°) in nine cases. The time to full weight-bearing was 5.9 months. The consolidation index was 1.07 (0.75-1.62) months/cm. Complete consolidation was obtained in all cases except two. Running back was observed in two cases. CONCLUSIONS The Fitbone technique allows accurate deformity correction. The rigid reamers allow the surgeon to use the Fitbone even in patients with a narrow medullary canal. As this might result in poor bone regeneration, thinner lengthening nails should be considered.
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Affiliation(s)
- Metin Küçükkaya
- Department of Orthopedics and Traumatology, İstanbul Bilim University, İstanbul, Turkey
- Büyükdere Cad. No:120 34394 Esentepe Şişli, İstanbul, Turkey
| | - Özgür Karakoyun
- Department of Orthopedics and Traumatology, Namık Kemal University, Tekirdağ, Turkey
- Namık Kemal Üniversitesi Tıp Fakültesi Dekanlığı Namık Kemal Mahallesi Kampüs, Caddesi No:1 Suleymanpasa, Tekirdağ, Turkey
| | - Sami Sökücü
- Department of Orthopedics and Traumatology, Metin Sabanci Baltalimani Osteopathic Training and Research Hospital, Istanbul, Turkey
- Rumeli Hisarı Caddesi No: 62, 34470 Baltalimanı İstanbul, Turkey
| | - Ramazan Soydan
- Department of Orthopedics and Traumatology, İstanbul Bilim University, İstanbul, Turkey
- Büyükdere Cad. No:120 34394 Esentepe Şişli, İstanbul, Turkey
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Zhang F, Zhu L, Li Y, Chen A. Retrograde versus antegrade intramedullary nailing for femoral fractures: a meta-analysis of randomized controlled trials. Curr Med Res Opin 2015; 31:1897-902. [PMID: 26337195 DOI: 10.1185/03007995.2015.1078783] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To conduct a meta-analysis of randomized controlled trials assessing the effect on clinical outcomes of intramedullary nailing for femoral fractures via a retrograde or antegrade approach. DATA SOURCES Randomized controlled trials using PubMed, Embase, and the Cochrane Library databases. STUDY SELECTION We used the following search terms with no language or study type restrictions: femoral shaft fractures, internal fixation, treatment outcome, intramedullary nailing, and retrograde or antegrade approach. DATA EXTRACTION Two independent authors extracted the data and we assessed the quality of the included studies based on Jadad score; allocation concealment; similarity of baseline characteristics; eligibility criteria; blinding; completeness of follow-up; and intention-to-treat analysis. Our primary outcome measure was the union rate and the secondary outcome measures were nonunion, knee pain, and heterotopic ossification. A total of 240 patients from three randomized controlled trials were included. DATA SYNTHESIS Risk ratios (RRs) and 95% confidence intervals (CIs) were computed for dichotomous variables, and weighted mean differences and 95% CIs for continuous variables. Heterogeneity among studies was assessed using the I (2) statistic, with I (2 )> 50% considered significant. If heterogeneity was not significant, a fixed effects model was chosen to assess the overall estimate. Otherwise, a random effects model was used. We used Egger's regression asymmetry test and Begg's adjusted-rank correlation to assess publication bias. CONCLUSIONS Both retrograde and antegrade intramedullary nailing produced high union rates. We found no significant difference in union rate between the retrograde nailing group and the antegrade nailing group for femoral fractures (RR 1.02, 95% CI: 0.94-1.11, p = 0.59, I (2 )= 0%).
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Affiliation(s)
- Fan Zhang
- a Department of Orthopedic Trauma Surgery , Orthopedic Institute of PLA, Shanghai Changzheng Hospital, Second Military Medical University , Shanghai , China
| | - Lei Zhu
- a Department of Orthopedic Trauma Surgery , Orthopedic Institute of PLA, Shanghai Changzheng Hospital, Second Military Medical University , Shanghai , China
| | - Yongchuan Li
- a Department of Orthopedic Trauma Surgery , Orthopedic Institute of PLA, Shanghai Changzheng Hospital, Second Military Medical University , Shanghai , China
| | - Aimin Chen
- a Department of Orthopedic Trauma Surgery , Orthopedic Institute of PLA, Shanghai Changzheng Hospital, Second Military Medical University , Shanghai , China
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Kömürcü E, Yüksel HY, Ersöz M, Aktekin CN, Hapa O, Çelebi L, Akbal A, Biçimoğlu A. Effect of surgical closing in total knee arthroplasty at flexion or extension: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 2014; 22:3067-73. [PMID: 24519622 DOI: 10.1007/s00167-014-2896-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 02/03/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effect of knee position during wound closure (flexed vs. extended) in total knee arthroplasty on knee strength and function, as determined by knee society scores and isokinetic testing of extensor and flexor muscle groups. METHODS In a prospective, randomized, double-blind trial, 29 patients were divided in two groups: for Group 1 patients, surgical closing was performed with the knee extended, and for Group 2 patients, the knee flexed at 90°. All the patients were treated with the same anaesthesia method, surgical team, surgical technique, prosthesis type, and rehabilitation process. American Knee Society Score values and knee flexion degrees were recorded. Isokinetic muscle strength measurements of both knees in flexion and extension were taken using 60° and 180°/s angular velocity. The peak torque and total work values, isokinetic muscle strength differences, and total work difference values were calculated for surgically repaired and healthy knees. RESULTS No significant difference in the mean American Knee Society Score values and knee flexion degrees was observed between the two groups. However, using isokinetic evaluation, a significant difference was found in the isokinetic muscle strength differences and total work difference of the flexor muscle between the two groups when patients were tested at 180°/s. Less loss of strength was detected in the isokinetic muscle strength differences of the flexor muscle in Group 2 (-4.2%) than in Group 1 (-23.1%). CONCLUSION For patients undergoing total knee arthroplasty, post-operative flexor muscle strength is improved if the knee is flexed during wound closure. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Erkam Kömürcü
- Department of Orthopedics and Traumatology, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey,
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Abstract
OBJECTIVES To analyze the rate of postoperative infection after retrograde femoral nail placement in the setting of traumatic knee arthrotomy (KA). DESIGN Retrospective. SETTING Level-I trauma center. PATIENTS A review of all adult femur fractures (N = 1748) treated with an intramedullary nail over a 10-year period identified 34 retrograde nails with traumatic KA as the study group and 23 antegrade nails with traumatic KA as a control group. The retrograde femoral traumatic KA group was also compared with a 4:1 matched control group of 136 patients with retrograde femoral nails without traumatic KA. INTERVENTION Retrograde femoral nail placement with traumatic KA. MAIN OUTCOME MEASUREMENTS Occurrence of postoperative infection. RESULTS The traumatic KA groups treated with retrograde and antegrade femoral nails were similar across all recorded patient variables. No infections occurred in the retrograde traumatic KA group versus 1 infection (4.3%) in the antegrade traumatic KA group (P = 0.404). Four nonunions (11.8%) occurred in the retrograde traumatic KA group versus 1 nonunion (4.3%) in the antegrade traumatic KA group (P = 0.638). The matched control group of retrograde nails did not significantly differ when compared with the retrograde traumatic KA group for infection or nonunion (P = 1.000 and 0.261). CONCLUSIONS This is the first study to investigate retrograde nail placement through traumatic KA with comparison to control groups, with no differences found in infection rates. Furthermore, no infections (knee or fracture) occurred in those patients who were treated using a retrograde femoral nail with traumatic KA. This study documents the relative safety associated with retrograde femoral nailing in the setting of a concurrent traumatic KA with surgical debridement.
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Abstract
OBJECTIVES This study was performed to determine (1) the incidence of humeral shaft fractures within the Medicare noncancer population, (2) the trends in utilization of humeral shaft fixation techniques by plate-and-screw devices and intramedullary nails, (3) differences in procedure times, and (4) the outcomes of individuals as measured by rate of secondary operations and 1-year mortality. DESIGN/SETTING Retrospective comparative cohort analysis. A cancer-free Medicare part B claims sample derived from a 5% sample from the years 1993 to 2007 was analyzed. PATIENTS/INTERVENTION Our cohorts were generated by diagnostic and procedural codes for humeral shaft fractures. MAIN OUTCOME MEASUREMENT The incidence of humeral shaft fracture and trend in operative fixation were evaluated for all years of data. Surgical times were assessed by anesthesia Current Procedural Terminology codes. Outcomes and complications were assessed by Current Procedural Terminology codes. The proportion of individuals experiencing complications and 1-year mortality were compared by proportion hazards. RESULTS We identified 1385 claims for humeral shaft fractures over 15 years, with an adjusted rate of between 12.0 and 23.4 fractures per 100,000 beneficiaries. We identified 511 individuals who received surgical treatment for humeral shaft fractures, 451 of whom had complete 1-year follow-up data. Nail fixation was more prevalent than plate fixation most years and had shorter anesthesia time by 27.1 minutes (P < 0.0001). There were no significant differences in the complication rates between the 2 groups as measured by incidence of secondary operations and 1-year mortality. CONCLUSIONS Intramedullary nails are used for the majority of operative humeral shaft fractures among Medicare beneficiaries. Nailing has a shorter mean operative time. The 2 surgical techniques had no significant differences in terms of risk of secondary procedures and 1-year mortality. LEVEL OF EVIDENCE : Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Foster Chen
- National Institutes of Health, 10 Center Dr., Building 10, Mail Code 1468, Bethesda, MD 20892-1150
| | - Zhong Wang
- National Institutes of Health, 10 Center Dr., Building 10, Mail Code 1468, Bethesda, MD 20892-1150
| | - Timothy Bhattacharyya
- National Institutes of Health, 10 Center Dr., Building 10, Mail Code 1468, Bethesda, MD 20892-1150
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el Moumni M, Voogd EH, ten Duis HJ, Wendt KW. Long-term functional outcome following intramedullary nailing of femoral shaft fractures. Injury 2012; 43:1154-8. [PMID: 22483542 DOI: 10.1016/j.injury.2012.03.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 12/06/2011] [Accepted: 03/06/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND The management of femoral shaft fractures using intramedullary nailing is a popular method. The purpose of this study was to evaluate the long-term functional outcome after antegrade or retrograde intramedullary nailing of traumatic femoral shaft fractures. We further determined predictors of these functional outcome scores. METHODS In a retrospective study, patients with a femoral shaft fracture but no other injuries to the lower limbs or pelvis were included. A total of 59 patients met the inclusion criteria. Functional outcome scores (Short Musculoskeletal Functional Assessment (SMFA), Western Ontario and McMaster University Osteoarthritis (WOMAC) index, Harris Hip Score (HHS) and the Lysholm knee function scoring scale) were measured at a mean of 7.8 years (± 3.5 years) postoperatively. The Visual Analogue Scale (VAS) was used to determine pain complaints of the lower limb. RESULTS The range of motion (ROM) of the hip and knee joints was comparable between the injured and uninjured leg, regardless of the nailing technique. Correlation between ROM and the final outcome scores was found to be fair to moderate. Even years after surgery, 17% of the patients still reported moderate to severe pain. A substantial correlation was observed between VAS and the patient-reported outcome scores. The most significant predictor of functional outcome was pain in the lower limb. CONCLUSIONS Our findings suggest that the ROM of hip and knee returns to normal over time, regardless of the nailing method used. However, pain in the lower limb is an important predictor and source of disability after femoral shaft fractures, even though most patients achieved good functional outcome scores.
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Affiliation(s)
- Mostafa el Moumni
- Department of Traumatology, University Medical Center Groningen, Groningen, The Netherlands.
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Abstract
Because standard femoral supracondylar nails have certain disadvantages, they are often replaced by traditional femoral or tibial locked nails. The purpose of this study was to make a biomechanical comparison between both types of traditional locked nails to determine which technique was more suitable for treating unstable femoral supracondylar fractures. Fourteen left Sawbones femurs (Pacific Research Laboratories, Vashon, Washington) were osteotomized in the femoral supracondylar area. One centimeter of the medial cortex in the proximal fragment was obliquely removed to simulate an unstable fracture without shortening. Seven specimens were treated with traditional retrograde dynamic femoral locked nails, and the other 7 with traditional retrograde dynamic tibial locked nails. All specimens were tested with a servohydraulic materials testing machine to compare their relative stability. Static compression, dynamic cyclic compression, and static compression to failure were tested. An extensometer was used to measure the displacement of fragments. Displacement between the fragments increased following the increment in loads in both nails. The load-displacement curve was nearly linear up to 1000 N for both nails. The femoral nail had a greater stiffness compared with the tibial nail at 100 and 200 N (P=.02 and P=.04, respectively) in static compression and at 700 to 1000 N (P=.01 in each case) in dynamic cyclic compression, as well as larger loads in static compression to failure (8663 vs 7547 N, respectively; P<.001). Clinically, a traditional femoral locked nail may be more suitable to replace a standard femoral supracondylar nail in a retrograde fashion to treat an unstable femoral supracondylar fracture.
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Affiliation(s)
- Chi-Chuan Wu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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