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Pradhan C, Altaf W, Attarde D, Sancheti P, Shyam A. A Case of Symmetrical Bilateral Bifocal Femur Fracture with Bilateral Patella Fracture - A Case Report! J Orthop Case Rep 2023; 13:7-10. [PMID: 38162357 PMCID: PMC10753664 DOI: 10.13107/jocr.2023.v13.i12.4056] [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: 09/23/2023] [Revised: 10/06/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Bilateral bifocal femur fractures occur as a result of high-velocity trauma mainly road traffic accidents with dashboard injuries or fall from height. These fractures can result in high morbidity or mortality as they are usually presented with hypovolemic shock or fatal fat embolism syndrome. Case Report We present a 47-year-old male with a history of fall from 35 feet. He sustained a symmetrical intertrochanteric femur fracture with a diaphyseal femur fracture with a bilateral patella fracture. There was no evidence of any head injury or spinal fracture. The patient reached the emergency room in hypotension and was maintaining saturation on room air. The patient was admitted to the intensive care unit; hypotension was corrected overnight and was operated on after 24 h with bilateral intramedullary long proximal femoral nail and tension band wiring for the bilateral patella fractures. At 1-year follow-up, he was able to do his daily activities with minimal limitation. Conclusion Bilateral bifocal femur fractures result from a high-velocity trauma. In such injuries, careful evaluation of all the systems should be performed to find out concomitant injuries. Single-staged surgical intervention decreases the morbidities of the subsequent surgeries, helps in a rehabilitation hospital stay as well as financially suitable for the patient.
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Affiliation(s)
- Chetan Pradhan
- Department of Orthopaedic, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
| | - Warid Altaf
- Department of Orthopaedic, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
| | - Dheeraj Attarde
- Department of Orthopaedic, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
| | - Parag Sancheti
- Department of Orthopaedic, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
| | - Ashok Shyam
- Department of Orthopaedic, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
- Indian Orthopaedic Research Group, Thane, Maharashtra, India
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Salman LA, Al-Ani A, Radi MFA, Abudalou AF, Baroudi OM, Ajaj AA, Alkhayarin M, Ahmed G. Open versus closed intramedullary nailing of femur shaft fractures in adults: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2023; 47:3031-3041. [PMID: 36864184 PMCID: PMC10673735 DOI: 10.1007/s00264-023-05740-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/20/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE This systematic review and meta-analysis aimed to compare the outcomes of open- versus closed-reduction and intramedullary nailing (IMN) of adult femur shaft fractures. METHODS Four databases were searched from inception until July 2022 for original studies that compared the outcomes of IMN following open-reduction versus closed-reduction technique. The primary outcome was the union rate; the secondary outcomes were time to union, nonunion, malalignment, revision, and infection. This review was conducted in line with PRISMA guidelines. RESULTS A total of 12 studies with 1299 (1346 IMN cases) patients were included, with a mean age of 32.3 ± 3.25. The average follow-up was 2.3 ± 1.45 years. There was a statistically significant difference in union rate (OR, 0.66; 95% CI, 0.45-0.97; p-value, 0.0352), nonunion (OR, 2.06; 95% CI, 1.23-3.44; p-value, 0.0056), and infection rate (OR, 1.94; 95% CI, 1.16-3.25; p-value, 0.0114) between the open-reduction and closed-reduction groups in favour of the latter. However, malalignment was significantly higher in the closed-reduction group (OR, 0.32; 95% CI, 0.16-0.64; p-value, 0.0012), whereas time to union and revision rates were similar (p = NS). CONCLUSION This study showed that closed-reduction and IMN had more favourable union rate, nonunion, and infection rates than the open-reduction group, yet malalignment was significantly less in the open-reduction group. Moreover, time to union and revision rates were comparable. However, these results must be interpreted in context due to confounding effects and the lack of high-quality studies.
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Affiliation(s)
- Loay A Salman
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
| | - Abdallah Al-Ani
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Mohammed F A Radi
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Abedallah F Abudalou
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Omar M Baroudi
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Abdulla A Ajaj
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Mohamed Alkhayarin
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ghalib Ahmed
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
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Yeh KL, Liaw CK, Wu TY, Chen CP. Radial nerve recovery following closed nailing of humeral shaft fractures without radial nerve exploration: A retrospective study. World J Clin Cases 2021; 9:8044-8050. [PMID: 34621861 PMCID: PMC8462186 DOI: 10.12998/wjcc.v9.i27.8044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/08/2021] [Accepted: 08/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Radial nerve palsy due to humeral shaft fracture is the most common peripheral nerve injury associated with long bone fractures. An antegrade nailing surgical technique is becoming popular for the fixation of these fractures with minimal invasiveness. We analyzed nerve recovery in patients with humeral shaft fracture and radial nerve palsy treated with humeral nail fixation without nerve exploration.
AIM To assess the radial nerve recovery rate and time from humeral shaft fracture with surgical treatment using close nailing.
METHODS We retrospectively collected data of patients who underwent undergone surgical nail fixation for humeral shaft fractures between October 1, 2016, and March 31, 2020. Subsequently, we analyzed the primary or secondary radial nerve palsy recovery rate and radial nerve motor function recovery time.
RESULTS The study included 70 patients who underwent surgical treatment for closed- or Gustilo type I open humeral shaft fractures using a nail fixation technique without radial nerve exploration. The patients suffered from primary (n = 5) and secondary (n = 5) radial nerve palsy. A 100% radial nerve recovery rate was achieved. The mean recovery time was 4.3 mo.
CONCLUSION The study results indicate full recovery of radial nerve palsies from humeral shaft fracture using close nailing treatment. Surgeons need not be concerned about the occurrence of permanent nerve palsies.
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Affiliation(s)
- Kuei-Lin Yeh
- Department of Orthopedics, Shin Kong Wu-Ho Su Memorial Hospital, Taipei City 111, Taiwan
| | - Chen-Kun Liaw
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 11031, Taiwan
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Graduate Institute of Biomedical Optomechatronics, College of Biomedical Engineering; Research Center of Biomedical Device, Taipei Medical University, Taipei City 11301, Taiwan
| | - Tai-Yin Wu
- Department of Family Medicine, Zhongxing Branch, Taipei City Hospital, Taipei City 10341, Taiwan
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei City 10055, Taiwan
- National Taipei University of Nursing and Health Science, Taipei City 11219, Taiwan
| | - Chung-Pei Chen
- Department of Orthopedics, Cathay General Hospital, New Taipei City 221, Taiwan
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Tahir M, Ahmed N, Faraz A, Shafiq H, Khan MN. Comparison of Open and Closed Nailing for Femoral Shaft Fractures: A Retrospective Analysis. Cureus 2021; 13:e16030. [PMID: 34336517 PMCID: PMC8319164 DOI: 10.7759/cureus.16030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction Open and closed nailing are the two reduction methods used for the fixation of femoral shaft fractures. The study aims to assess the clinical and functional outcomes of open and closed nailing for closed femoral shaft fractures. Methodology A total of 398 patients who underwent intramedullary nailing fixation of nonpathological femoral shaft fracture between January 2016 to December 2019 were reviewed retrospectively. Two hundred seventy-four underwent closed nailing, and 124 were considered for open nailing. Results The primary outcome reviewed was the union rate of fracture. Other outcomes analyzed were complications, intraoperative blood loss, time to union, and the duration of the procedure. Patients in the open group had a union of fracture in 15.71 weeks, closed nailing group had a union in 15.53 weeks (p-value 0.495). Patients with open nailing had a mean Radiological union scale in tibial (RUST) fracture score of 11.435, whereas the closed nailing group had a mean of 11.664 (p-value 0.187). Operative time was higher in the open group when compared to the closed nailing group (p-value 0.000). However, intraoperative blood loss was more in open nailing in comparison to closed nailing. Furthermore, 15 patients with closed nailing had non-union, whereas 11 had non-union after open nailing (p-0.204). Superficial infection and deep infection requiring debridement were equally observed among the two treatment groups. Conclusion Fixation of femoral shaft fractures with open nailing has similar outcomes in union rates, time to union, and rates of significant complication similar to those of close nailing.
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Affiliation(s)
- Muhammad Tahir
- Orthopaedics, Jinnah Postgraduate Medical Center, Karachi, PAK
| | - Nadeem Ahmed
- Orthopaedics and Traumatology, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Ahmad Faraz
- Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds, GBR
| | - Hassan Shafiq
- Trauma and Orthopaedics, Royal National Orthopaedic Hospital, London, GBR
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Adesina SA, Eyasan SU, Amole IO, Awotunde OT, Akinwumi AI, Durodola AO, Ikem IC. Closed reduction and locked intramedullary nailing of diaphyseal long bone fractures without intra-operative imaging and fracture table. INTERNATIONAL ORTHOPAEDICS 2021; 46:51-59. [PMID: 34131767 DOI: 10.1007/s00264-021-05091-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Early closed reduction and locked intramedullary (IM) nailing has become the standard treatment for diaphyseal long bone fractures in high income countries. The low and middle income countries (LMICs) are still lagging behind in transiting from open surgical reduction and non-operative modalities to closed reduction due to lack of requisite equipment. However, some surgeons in LMICs are beginning to achieve closed reduction even without the equipment. METHODS A prospective descriptive study was done on a total of 251 fresh diaphyseal fractures of the humerus, femur and tibia fixed with a locked nail over a 5½-year period. The fractures were grouped into those that had open reduction, closed reduction or reduction with a finger. RESULTS Closed reduction was done for 135 (53.8%) fractures belonging to 123 patients. The mean and range of the patients' ages were 41.33 and 13-81 years, respectively. Males constituted 69.9% and mostly (48%) sustained fractures in motorcycle accident. There was a significant negative association between closed reduction and fracture-to-surgery interval (p < 0.001). Closed reduction also had positive associations with: (i) humerus and tibia fractures (p < 0.001), (ii) middle, distal and segmental fractures (p = 0.025), (iii) retrograde approach to femur fracture nailing (p < 0.001), and (iv) wedge or multifragmentary type femur fractures (p = 0.005). CONCLUSION With constant practice, it is possible to achieve closed reduction of many fresh diaphyseal long bone fractures in spite of the limitations imposed on surgeons in LMICs by poor health systems and grossly inadequate fracture care facilities.
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Affiliation(s)
- Stephen Adesope Adesina
- Department of Family Medicine, Bowen University , Iwo, Osun State, Nigeria. .,Department of Family Medicine, Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria.
| | - Samuel Uwale Eyasan
- Department Surgery, Bowen University, Iwo, Osun State, Nigeria.,Department Surgery, Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | - Isaac Olusayo Amole
- Department of Family Medicine, Bowen University , Iwo, Osun State, Nigeria.,Department of Family Medicine, Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | - Olufemi Timothy Awotunde
- Department of Family Medicine, Bowen University , Iwo, Osun State, Nigeria.,Department of Family Medicine, Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | | | - Adewumi Ojeniyi Durodola
- Department of Family Medicine, Bowen University , Iwo, Osun State, Nigeria.,Department of Family Medicine, Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | - Innocent Chiedu Ikem
- Department of Orthopaedic Surgery and Traumatology, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
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Ghouri SI, Asim M, Mustafa F, Kanbar A, Ellabib M, Al Jogol H, Muneer M, Abdurraheim N, Goel AP, Abdelrahman H, Al-Thani H, El-Menyar A. Patterns, Management, and Outcome of Traumatic Femur Fracture: Exploring the Experience of the Only Level 1 Trauma Center in Qatar. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115916. [PMID: 34072990 PMCID: PMC8198965 DOI: 10.3390/ijerph18115916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 11/16/2022]
Abstract
Background: Femur is the most fractured long bone in the body that often necessitates surgical fixation; however, data on the impact of the mechanism of injury (MOI), age, and timing of intervention are lacking in our region of the Arab Middle East. We aimed to describe the patterns, management, and outcome of traumatic femoral shaft fractures. Methods: A retrospective descriptive observational study was conducted for all trauma patients admitted with femoral shaft fractures between January 2012 and December 2015 at the only level 1 trauma center and tertiary hospital in the country. Data were analyzed and compared according to the time to intervention (intramedullary nailing; IMN), MOI, and age groups. Main outcomes included in-hospital complications and mortality. Results: A total of 605 hospitalized cases with femur fractures were reviewed. The mean age was 30.7 ± 16.2 years. The majority of fractures were unilateral (96.7%) and 91% were closed fractures. Three-fourths of fractures were treated by reamed intramedullary nailing (rIMN), antegrade in 80%. The pyriform fossa nails were used in 71.6% while trochanteric entry nails were used in 28.4%. Forty-five (8.9%) fractures were treated with an external fixator, 37 (6.1%) had conservative management. Traffic-related injuries occurred more in patients aged 14–30 years, whereas fall-related injuries were significantly higher in patients aged 31–59. Thirty-one patients (7.8%) had rIMN in less than 6 h post-injury, 106 (25.5%) had rIMN after 6–12 h and 267 (66.8%) had rIMN after more than 12 h. The implant type, duration of surgery, DVT prophylaxis, in-hospital complications, and mortality were comparable among the three treatment groups. Conclusions: In our center, the frequency of femoral fracture was 11%, and it mainly affected severely injured young males due to traffic-related collisions or falls. Further multicenter studies are needed to set a consensus for an appropriate management of femur fracture based on the MOI, location, and timing of injury.
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Affiliation(s)
- Syed Imran Ghouri
- Department of Surgery, Orthopedic Surgery, Hamad General Hospital, Doha, Qatar;
| | - Mohammad Asim
- Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar;
| | - Fuad Mustafa
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar; (F.M.); (A.K.); (M.E.); (H.A.J.); (N.A.); (A.P.G.); (H.A.)
| | - Ahad Kanbar
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar; (F.M.); (A.K.); (M.E.); (H.A.J.); (N.A.); (A.P.G.); (H.A.)
| | - Mohamed Ellabib
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar; (F.M.); (A.K.); (M.E.); (H.A.J.); (N.A.); (A.P.G.); (H.A.)
| | - Hisham Al Jogol
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar; (F.M.); (A.K.); (M.E.); (H.A.J.); (N.A.); (A.P.G.); (H.A.)
| | - Mohammed Muneer
- Department of Surgery, Plastic Surgery, Hamad General Hospital, Doha, Qatar;
| | - Nuri Abdurraheim
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar; (F.M.); (A.K.); (M.E.); (H.A.J.); (N.A.); (A.P.G.); (H.A.)
| | - Atirek Pratap Goel
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar; (F.M.); (A.K.); (M.E.); (H.A.J.); (N.A.); (A.P.G.); (H.A.)
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar; (F.M.); (A.K.); (M.E.); (H.A.J.); (N.A.); (A.P.G.); (H.A.)
| | - Hassan Al-Thani
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar;
| | - Ayman El-Menyar
- Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar;
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
- Correspondence: ; Tel.: +974-44396130
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Korica S, Virijević D, Glišović-Jovanović I, Tabaković D, Kadija M. Intramedular fixation after breaking of the femoral plate. PRAXIS MEDICA 2021. [DOI: 10.5937/pramed2104041k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Any fracture of the femoral shaft presents a challenge to the orthopedic surgeon. Femoral fractures most often occur within polytrauma, by forces of high intensity as is the case with traffic accidents. There are two methods to treat with internal fracture fixation, intra and extra medullary fixation. Both treatments have their advantages and disadvantages and it is necessary to make a good preoperative plan. We present the case of a 23-year-old man who suffered a femoral shaft fracture as a driver in a car accident. He was initially surgically treated with orthopedic repositioning and internal, extramedullary fixation. After 18 months, bending of the osteosynthetic material and dislocation of the fragments with varus and recurvatum were verified. Oligotrophic pseudoarthrosis was also present. Reintervention and fixation with interlocking nail was performed. The weight bearing is allowed after two weeks. After 3 months, patient has full range of motion and there is no palpatory painful sensitivity. Intramedullary fixation is the method of choice for fractures of the femur, especially when there is no comminution and in cases of open fractures of the first and second degree. Rotation of fragments is locked, physical rehabilitation is faster and there is less risk of mal union.
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Does Open Reduction in Intramedullary Nailing of Femur Shaft Fractures Adversely Affect the Outcome? A Retrospective Study. Adv Orthop 2020; 2020:7583204. [PMID: 32547791 PMCID: PMC7273415 DOI: 10.1155/2020/7583204] [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: 12/13/2019] [Revised: 02/13/2020] [Accepted: 02/28/2020] [Indexed: 11/17/2022] Open
Abstract
Aim This study aims to assess the results of open versus closed reduction in intramedullary nailing for femoral fractures and whether it delays union, predisposes to nonunion, or increases the rate of infection. Materials and Methods A retrospective review of all adult patients with isolated femoral shaft fractures treated by intramedullary nailing was done. The primary outcome is union rate, and the secondary outcomes are operation time and the infection rate. Results 110 isolated femoral shaft fractures, with 73 (66.4%) in the closed reduction group and 37 (33.6%) in the open reduction group, 90.4% males and 9.6% females, and the average age was 32.6 years. RTA is the most common cause of these injuries followed by the fall from height. The delayed union rate was 20% (22/110) with no difference between the two groups, p value 0.480, and the nonunion rate was 5.5% (6/110), and no statistical difference was observed between the two groups. The operation time was shorter in the closed groups, and no difference in the time to union was observed between two groups. No infection was found in the two groups. Conclusions There is no statistical difference between the healing rates in closed and open reduction in femoral shaft fractures. In cases where closed reduction is difficult, it is better to open reduce the fracture if closed reduction cannot be achieved in 15 minutes, especially in polytrauma.
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Liu Y, Zheng Y, Shen Z, Wang S, Wei X, Gu X, Zhan H, Kuang Y. Interlocking intramedullary nail fixation with additional bone grafting from trochanter via a femoral hollow trephine in the treatment of femoral shaft fractures: design and clinical application. INTERNATIONAL ORTHOPAEDICS 2016; 41:397-402. [PMID: 27234421 DOI: 10.1007/s00264-016-3207-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 04/18/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to describe and evaluate the clinical application of the technique of interlocking intramedullary (IM) nailing via an entry point at the tip of greater trochanter using a specially designed femoral hollow trephine to stabilize diaphyseal fractures of the femur. METHODS From February 2010 to April 2014, 35 consecutive patients with femoral shaft fractures were treated by the therapy of bone grafting from trochanter region with interlocking IM nail. The average age of these 23 male and 12 female patients was 37.5 years (range, 22-67 years). Fractures were classified according to AO classification system (15 type A, 17 type B, 3 type C). Femoral canal reaming and the collection of cancellous bone were simultaneously performed in a single step with the specially designed femoral hollow trephine, followed by regular IM nailing procedure. RESULTS Of the 35 cases, the mean volume of spongy bone obtained was 5.63 cm3 (range, 3.0-7.0 cm3). Thirty-five patients with femoral shaft fractures had a mean follow-up period of 16.2 months (range, 12-22 months). All patients achieved bony union, at a mean of 5.4 months (range, 4-6 months). No patient developed a delayed union or a nonunion. There were no complications such as infections, injury of vascular and nerve, or heterotopic ossification in hip. CONCLUSIONS These results indicate that the technique of use of IM nailing with the femoral hollow trephine significantly decreases the occurrence of nonunion in femoral shaft fractures.
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Affiliation(s)
- Yinwen Liu
- Department of Orthopaedic and Traumatology, Shuguang Hospital affiliated to Shanghai TCM University, No. 528 Zhangheng Road, Shanghai, 201203, China
| | - Yuxin Zheng
- Department of Orthopaedic and Traumatology, Shuguang Hospital affiliated to Shanghai TCM University, No. 528 Zhangheng Road, Shanghai, 201203, China
| | - Ziliang Shen
- Department of Orthopaedic and Traumatology, Shuguang Hospital affiliated to Shanghai TCM University, No. 528 Zhangheng Road, Shanghai, 201203, China
| | - Shuqiang Wang
- Department of Orthopaedic and Traumatology, Shuguang Hospital affiliated to Shanghai TCM University, No. 528 Zhangheng Road, Shanghai, 201203, China
| | - Xiaoen Wei
- Department of Orthopaedic and Traumatology, Shuguang Hospital affiliated to Shanghai TCM University, No. 528 Zhangheng Road, Shanghai, 201203, China
| | - Xinfeng Gu
- Department of Orthopaedic and Traumatology, Shuguang Hospital affiliated to Shanghai TCM University, No. 528 Zhangheng Road, Shanghai, 201203, China
| | - Hongsheng Zhan
- Department of Orthopaedic and Traumatology, Shuguang Hospital affiliated to Shanghai TCM University, No. 528 Zhangheng Road, Shanghai, 201203, China.
| | - Yong Kuang
- Department of Orthopaedic and Traumatology, Shuguang Hospital affiliated to Shanghai TCM University, No. 528 Zhangheng Road, Shanghai, 201203, China
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