Improve the Efficiency of Surgery for Femoral Shaft Fractures with A Novel Instrument: A Randomized Controlled Trial

A novel reduction device for the minimally invasive treatment of femoral shaft fractures

OBJECTIVE

In this study, a new type of reduction device for femoral shaft fractures was developed and designed. The reduction procedure was also standardized and is expected to be useful in clinical practice.

METHODS

A bone traction retractor that consisted of a special traction needle, a resistant sleeve, a crossbar and an arc-adjusting bar was designed. Forty-eight patients (32 males and 16 females, mean age 33.21±7.03 years old) with femoral shaft fractures treated in our hospital from January 2016 to December 2017 were selected. According to the AO classification, there were 15 patients with type A, 24 patients with type B and 9 patients with type C fractures. All patients were treated with transverse bone traction for closed reduction of femoral shaft fractures and femoral reconstruction with intramedullary nails for final fixation. The injured side, preoperative delay time, reduction and operative times, operative blood loss, drilling frequency, number of open reduction cases, hospitalization days, fracture healing time, postoperative HSS function score and complications were recorded.

RESULTS

All 48 patients were treated with transverse bone traction using our novel device to obtain reduction. The average time needed for reduction was 19.98±4.66 min. The operating time was 60-100 min, with an average of 78.65±16.81 min, and the average intraoperative blood loss was 131.91±30.22 ml. Open reduction was performed in 8 patients: 1 patient in the experimental group and 7 patients in the control group. The average hospitalization days was 7.78±2.81 days, the fracture healing time was 10 to 15 weeks, with an average of 12.44±2.63 weeks, and the postoperative HSS score was 80-95 points, with an average of 86.52±6.03 points. None of the patients had coxa vara, nonunion, internal fixation failure, infection, nerve injury, limb length discrepancy or other complications.

CONCLUSION

In this study, the transverse bone traction reduction technique and the design of a proprietary reduction device system were proposed, with high clinical application. The transverse bone traction reduction technique has the advantages of simple operation, reliable reduction and limited intraoperative fluoroscopy in the minimally invasive treatment of femoral shaft fractures.

Development of a novel fracture fragment stabilization system for minimally invasive osteosynthesis and in vitro comparison to traditional Kern bone reduction forceps

OBJECTIVE

To develop and evaluate a novel fracture fragment stabilization system, the Sirius minimally invasive bone reduction handle system (SMH), in an artificial fracture model (FxM) simulating a canine femoral fracture repair with a minimally invasive orthopedic approach.

STUDY DESIGN

In vitro experimental study.

SAMPLE POPULATION

Synthetic fractured femurs with soft-tissue coverage analog (n = 8).

METHODS

The developed SMH consisted of modified Kern forceps connected with existing external skeletal fixation components. Intramedullary Steinman pin placement with the SMH or traditional Kern forceps only (KO) was performed by 16 participants in randomized order. Demographics and surgical experience of participants and outcome variables (fragment movement, early/final gap formation, time of procedure, assessed practicability by visual analog scale) were recorded and statistically evaluated.

RESULTS

The SMH was more difficult and took longer to assemble (P = .031 and P = .008); SMH resulted in a smaller final reduction gap (P = .008). More surgical experience resulted in faster surgery times (R² = 0.766) but was not correlated with final fracture gap formation.

CONCLUSION

The SMH was associated with reduced fragment gap formation in this simulated setting.

CLINICAL SIGNIFICANCE

The SMH may be helpful for maintaining reduction of femoral fractures in dogs. Additional studies of the SMH should be conducted to fully assess the effectiveness and practicality in clinical cases.