Antegrade nailing of femoral shaft fractures combined with neck or distal femur fractures

Polytrauma remains a major social, economic and medicine affliction. Successful surgical treatment of polytrauma patient?s requires an approach predicated on prioritizing injuries. An isolated fractures rarely poses any threat but in association with multiple injuries, a fractures assumes greater significance. Proper management of femur fractures in polytrauma can greatly reduce the mortality and morbidity. In this work the results of the operative treatments of the femoral shaft fractures in polytrauma patients using Mitkovic type internal fixator (14 patients) and Kuntscher nail (9 patients) are compared. The average patients age was 28.43 years (range 16 to 61). Internal fixation using Mitkovic type internal fixator can be method of choose in treatment of femur fractures in polytrauma patient?s. Its application is relatively simple. It doesn?t damage the periosteal and meduullary bone vascularization, which favors osteosynthesis and provides considerable contribution in osteogensis. .

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Fracture Table vs. Lateral Positioning for Intramedullary Fixation of Femur Fractures (The FLiP Study): A protocol for a pilot randomized controlled trial

10.7287/peerj.preprints.27875v2 ◽

2019 ◽

Author(s):

Daniel Axelrod ◽

Herman Johal ◽

Kim Madden ◽

Francesc Marcano ◽

Carlos Prada

Keyword(s):

Pilot Trial ◽

Case Series ◽

Femoral Shaft ◽

Intramedullary Fixation ◽

Femoral Shaft Fractures ◽

Randomized Controlled ◽

Femur Fractures ◽

Shaft Fractures ◽

Fracture Table ◽

Lateral Positioning

Background: Femoral Shaft fractures are devastating and life threatening injuries. Femoral shaft fractures are most commonly treated with intramedullary fixation. Malrotation of the injured limb after fixation is a common and significant complication following femoral shaft fractures. During the operation, patients can be positioned either supine or in a lateral position. Additionally, patients can be placed on a standard radiolucent operating room table, or placed on a fracture table with traction statically applied to the operative limb throughout the case. Previous case series and cohort studies have shown equivalence between study groups, but choice between positioning options remains controversial. Methods: This represents a protocol for a randomized controlled pilot trial. We will be compared lateral positioning with use of manual traction to supine positioning with use of a fracture table. Primary outcomes will be in assessment for feasibility for a future full scale randomized trial, including evaluating patient recruitment, patient compliance with followup, contamination between treatment arms and others. Results: The primary outcome will be feasibility for a future trial. Secondary outcomes will include malrotation as measured through postoperative computed tomography scans and gait analysis at 6 months.

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Fracture Table vs. Lateral Positioning for Intramedullary Fixation of Femur Fractures (The FLiP Study): A protocol for a pilot randomized controlled trial

10.7287/peerj.preprints.27875 ◽

2019 ◽

Author(s):

Daniel Axelrod ◽

Herman Johal ◽

Kim Madden ◽

Francesc Marcano ◽

Carlos Prada

Keyword(s):

Pilot Trial ◽

Case Series ◽

Femoral Shaft ◽

Intramedullary Fixation ◽

Femoral Shaft Fractures ◽

Randomized Controlled ◽

Femur Fractures ◽

Shaft Fractures ◽

Fracture Table ◽

Lateral Positioning

Background: Femoral Shaft fractures are devastating and life threatening injuries. Femoral shaft fractures are most commonly treated with intramedullary fixation. Malrotation of the injured limb after fixation is a common and significant complication following femoral shaft fractures. During the operation, patients can be positioned either supine or in a lateral position. Additionally, patients can be placed on a standard radiolucent operating room table, or placed on a fracture table with traction statically applied to the operative limb throughout the case. Previous case series and cohort studies have shown equivalence between study groups, but choice between positioning options remains controversial. Methods: This represents a protocol for a randomized controlled pilot trial. We will be compared lateral positioning with use of manual traction to supine positioning with use of a fracture table. Primary outcomes will be in assessment for feasibility for a future full scale randomized trial, including evaluating patient recruitment, patient compliance with followup, contamination between treatment arms and others. Results: The primary outcome will be feasibility for a future trial. Secondary outcomes will include malrotation as measured through postoperative computed tomography scans and gait analysis at 6 months.

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Displaced femoral shaft fractures treated by antegrade nailing with the assistance of an intramedullary reduction device

International Orthopaedics ◽

10.1007/s00264-015-3036-8 ◽

2015 ◽

Vol 40 (8) ◽

pp. 1735-1739 ◽

Cited By ~ 7

Author(s):

Wei Chen ◽

Yongmin Jing ◽

Hongzhi Lv ◽

Juan Wang ◽

Zhiyong Hou ◽

...

Keyword(s):

Femoral Shaft ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Antegrade Nailing

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Femoral shaft fractures in children with non-ambulatory neuromuscular disorders can be effectively treated using flexible intramedullary nails

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.14.190154 ◽

2020 ◽

Vol 14 (2) ◽

pp. 132-138 ◽

Cited By ~ 2

Author(s):

Ali A. Siddiqui ◽

Kenneth D. Illingworth ◽

Oussama A. Abousamra ◽

Erin M. Meisel ◽

Robert M. Kay

Keyword(s):

Neuromuscular Disorders ◽

Femoral Shaft ◽

Control Group ◽

Angular Deformity ◽

Intramedullary Nails ◽

Femoral Shaft Fractures ◽

Femur Fractures ◽

Shaft Fractures ◽

Fractures In Children ◽

Flexible Intramedullary Nails

Purpose There is little information in the literature regarding flexible intramedullary nails (FIN) for treating femur fractures in children with neuromuscular disorders. The purpose of this study is to investigate the outcomes of FIN for femoral shaft fractures in non-ambulatory children with neuromuscular disorders. Methods A retrospective review was conducted on patients with femur fractures at a paediatric hospital between 2004 and 2018. Inclusion criteria were femoral shaft fracture treated with FIN. Outcomes were compared between patients with neuromuscular disorders (NM group) and a control group of those without neuromuscular disorders. Results A total of 37 patients with 37 femoral shaft fractures were studied (12 patients in the NM group and 25 in the control group). All NM group patients were non-ambulatory at baseline. Fractures were length stable in all 25 patients in the control group and in 2/12 (17%) patients in the NM group. All fractures healed in both groups. Three complications (all nail migrations) requiring reoperation before fracture union occurred in the NM group, yielding a major complication rate of 25% (3/12) in the NM group versus 0% (0/25) in controls (p = 0.03). Angular deformity occurred in 5/12 (42%) NM group patients and 1/25 (4%) control group patient (p = 0.009); none required reoperation. Conclusion Femur fractures in non-ambulatory children with neuromuscular disorders can be successfully treated with FIN. Angular deformities are common in this population, but had no functional impact in the non-ambulatory NM group patients. Surgeons must also be vigilant for implant prominence and skin breakdown in these patients. Level of evidence III

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Assessment of clinical and radiographic outcomes following retrograde versus antegrade nailing of infraisthmic femoral shaft fractures without the use of intraoperative fluoroscopy in Tanzania

OTA International ◽

10.1097/oi9.0000000000000125 ◽

2021 ◽

Vol 4 (2) ◽

pp. e125

Author(s):

Ericka P. von Kaeppler ◽

Claire A. Donnelley ◽

Heather J. Roberts ◽

Edmund N. Eliezer ◽

Billy T. Haonga ◽

...

Keyword(s):

Femoral Shaft ◽

Femoral Shaft Fractures ◽

Radiographic Outcomes ◽

Shaft Fractures ◽

Antegrade Nailing ◽

Intraoperative Fluoroscopy

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Flexible intramedullary nails: the panacea for paediatric femoral shaft fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20171596 ◽

2017 ◽

Vol 3 (3) ◽

pp. 411

Author(s):

Jagdeep Singh ◽

Jagandeep S. Virk ◽

Anoop Kalia ◽

Naveen Mittal

Keyword(s):

Stainless Steel ◽

Full Range ◽

Femoral Shaft ◽

Grey Zone ◽

Age Group ◽

Intramedullary Nails ◽

Femoral Shaft Fractures ◽

Femur Fractures ◽

Shaft Fractures ◽

Flexible Intramedullary Nails

Background: Management of pediatric femoral shaft fractures continues to evolve with time with flexible intramedullary nailing being one of the options to treat a specific age group of children. Grey zone exists concerning the cost effectiveness and appropriate timing of nail removal in treating such fractures. The objective of the study was to evaluate the treatment outcome of fracture shaft of the femur in children in the age group of 5- 12 years with flexible intramedullary nail.Methods: The study comprised of 30 consecutive cases of acute fractures of the femoral shaft in children of the age group of 5 to 12 years. Only closed fractures of the mid-diaphyseal region of the femur were included while supracondylar, subtrochanteric and pathological fractures were excluded. Flexible intramedullary nails of stainless steel (n=24) or titanium (n=6) were used for fixation of these fractures.Results: Evaluation of the results was done according to the criteria by Flynn et al. 21(70%) out of 30 patients had an excellent result and remaining 9 (30%) had a satisfactory result. All fractures united with a full range of motion at the hip and knee joint without any major complications. Conclusions: Intramedullary elastic nailing of simple diaphyseal femur fractures in children is an effective method with negligible complications. Treatment cost can be significantly lowered by using the much cheaper stainless steel flexible nails rather than the more expensive titanium nails.

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TENS for the surgical management of femoral shaft fractures in 6-14 years age group children

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors5213-21 ◽

2017 ◽

Vol 5 (2) ◽

pp. 13-21

Author(s):

Mohit Khanna ◽

Jitendra Wadhwani ◽

Amit Batra ◽

Sidharth Yadav ◽

Sarfraz Iman ◽

...

Keyword(s):

Prospective Study ◽

Weight Bearing ◽

Femoral Shaft ◽

Full Weight Bearing ◽

External Fixators ◽

Age Group ◽

Femoral Shaft Fractures ◽

Femur Fractures ◽

Shaft Fractures ◽

Fractures In Children

Background. Fracture shaft of femur in pediatric age group is one of the most common leading emergencies. Children in the age group of 6-14 years are treated with either traction, hip spica, flexible/elastic stable retrograde intramedullary nail, or external fixators. We conducted a clinical prospective study on the use of Titanium Elastic Nailing System (TENS) for the treatment of femoral shaft fractures in children. Methods. The prospective study included 45 cases of fresh femoral shaft fractures. The Inclusion Criteria were a) Age group of 6-14 years, b) Recent fracture of femur shaft c) Transverse, short oblique, minimally comminuted fractures. Results. The clinical results were evaluated using Flynn’s criteria of scoring as, Excellent in 40 patients (88.89 %), Satisfactory in 5 patients (11.12 %) and poor in none. Radiological criteria for fracture union were assessed by using Anthony et al scale. Nine patients developed bursitis at entry point of the nail. Three patients had superficial infection due to bursitis. Full weight bearing was possible in mean time of 8.7 weeks (range; 7-12 weeks). Conclusion. TENS is very effective in management of paediatric shaft femur fractures in the age group of 6-14 years with advantages of early union, early mobilization and manageable complications.

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Bridge Plating of Comminuted Shaft of Femur Fractures

Journal of Nobel Medical College ◽

10.3126/jonmc.v3i1.12230 ◽

2015 ◽

Vol 3 (1) ◽

pp. 7-12

Author(s):

Mohammad Abul Kalam ◽

Pradeep Kumar ◽

Mohammad Afzal Hussain ◽

Iqbal Ahmad

Keyword(s):

Prospective Study ◽

Plate Osteosynthesis ◽

Femoral Shaft ◽

Invasive Technique ◽

Operating Table ◽

Femoral Shaft Fractures ◽

Femur Fractures ◽

Shaft Fractures ◽

Bridge Plate ◽

Bridge Plating

A prospective study of forty comminuted femoral shaft fractures, open and close, treated with a relatively minimally invasive technique termed as bridge plate osteosynthesis or biological fixation. Less invasive procedure, Short operative time and less blood loss was seen during surgical procedure. This prospective study was conducted at Nobel Medical College, Biratnagar from 2010 to 2011. This study was done because most of the femoral shaft fractures treated under C-arm mobile image intensifier but bridge plating system does not require such advanced costly equipment. Almost all cases were free from long term complications. All fractures healed within 6 months. Bone grafting was done for 2 cases as a secondary procedure. The complication of infections was seen in two of open fractures. This procedure can easily be carried out in general operating table by appropriable surgeons.DOI: http://dx.doi.org/10.3126/jonmc.v3i1.12230Journal of Nobel Medical CollegeVol. 3, No.1 Issue 6, 2014, Page: 7-12

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Effect of inherent tibial asymmetry on leg length discrepancy measurements after intramedullary nailing of comminuted femoral shaft fractures

SICOT-J ◽

10.1051/sicotj/2018053 ◽

2019 ◽

Vol 5 ◽

pp. 1 ◽

Cited By ~ 3

Author(s):

Ian Hudson ◽

Krystalyn Mauch ◽

Meg Schuurman ◽

Muhammad T. Padela ◽

Petra Gheraibeh ◽

...

Keyword(s):

Intramedullary Nailing ◽

Femoral Shaft ◽

Leg Length Discrepancy ◽

Leg Length ◽

Femoral Shaft Fractures ◽

Length Discrepancy ◽

Femur Fractures ◽

Shaft Fractures ◽

Bony Landmarks ◽

Total Leg

Introduction: Locked intramedullary nailing (IMN) is the standard treatment for femoral shaft fractures in adults with high rates of union and relatively low rates of complications. Leg length discrepancy (LLD) after IMN of femoral shaft fractures is common, and is reported in 20–43% of cases. A known surgical challenge when trying to obtain equal leg lengths is comminuted fracture, which results in a loss of bony landmarks that guide reduction. The purpose of this study was to assess the effect of inherent tibial asymmetry on LLD measurements after IMN. Methods: Postoperative CT scanograms were performed on 79 consecutive patients after locked IMN for comminuted femoral shaft fracture. Leg lengths were determined by measurements taken from the scout view of a CT scanogram. Calculations of discrepancy were made for both femurs, tibias, and total leg length. Assessment was also made on the frequency wherein the tibial discrepancy compounded the femoral discrepancy. In situations where a limb segment was exactly symmetric to the contralateral side, the total leg was not regarded as a having compounded asymmetry. Results: Notable discrepancies were found in tibial length that significantly departed from the null of symmetry (p < 0.0001). Forty-two patients (53.2%) were found to have a tibial asymmetry of 3 mm or more, and 20 patients (25.3%) were found to exhibit a difference of 6.3 mm or more. Median femoral discrepancy was 5.3 mm and median tibial discrepancy was 3.0 mm. Seven patients were found to be asymmetric in total leg length as a consequence of underlying tibial asymmetry. Conversely, 11 patients benefited from their tibial asymmetry, which compensated for femoral asymmetry after IMN. Conclusion: Tibial symmetry cannot be assumed. If not accounted for, inherent tibial asymmetry may influence LLD after IMN of femur fractures.

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