Does Open Reduction in Intramedullary Nailing of Femur Shaft Fractures Adversely Affect the Outcome? A Retrospective Study

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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Radiographic Outcomes of Treatment of Complex Femoral Shaft Fractures by Intramedullary Nailing: A Retrospective Analysis of Different Techniques

10.21203/rs.3.rs-539520/v1 ◽

2021 ◽

Author(s):

Yu-Hung Chen ◽

Shang Ming Lin ◽

Chih-Hung Chang ◽

Tsung-Yu Lan

Keyword(s):

Intramedullary Nailing ◽

Closed Reduction ◽

Open Reduction ◽

Femoral Shaft ◽

Union Rate ◽

Femoral Shaft Fractures ◽

Reduction Group ◽

Diaphyseal Fractures ◽

The Difference ◽

Radiographic Union

Abstract BackgroundThis study aimed to determine whether the outcomes of femoral diaphyseal fractures (AO/OTA/32-C) were dependent on the treatment technique (closed vs. open reduction and internal ﬁxation with an interlocking nail).This retrospective study was conducted at a level III trauma center. A total of 47 consecutive patients with femoral diaphyseal fractures (AO/OTA/32-C) were included. All patients underwent reduction and fixation and were divided into two groups according to the surgical techniques used: closed reduction and open reduction groups. The radiographic union score of the femur, mean union time, re-operation rate, and complication rate were assessed.ResultsAt 12 postoperative months, the union rate was 80.76% in the open reduction group and 82.35% in the closed reduction group; however, the difference was not significant (p=0.787). The rate of anatomical-to-small gaps was 96.15% and 47.05% in the open and closed reduction groups, respectively (p=0.01). The radiographic union score of the femur at 6 postoperative months (9.30 vs. 7.76, p=0.02) and postoperative months (9.94 vs. 10.80, p=0.03) was significantly higher in the open reduction group. Further, the required time to union in the open reduction group was significantly shorter (7.39 vs. 9.18 months, p=0.025). The difference in the need for revision surgery was not significant between the two groups (19.23% vs. 23.52%, p=0.964). ConclusionsCompared to closed reduction, intramedullary nailing of severe comminuted femoral shaft fractures with open reduction has similar outcomes and carries no increased risk of complications. Surgeons should consider open reduction if the outcomes of closed reduction are not satisfactory. This will aid in restoring anatomical reduction, enable primary bone grafting, and result in an optimal union rate, better strength of union, and shorter time to union.

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The design of an “H” joystick for closed reduction and its application in segmental and comminuted femoral shaft fractures: an innovative technique

10.21203/rs.3.rs-26674/v2 ◽

2020 ◽

Author(s):

Zhaofeng Jia ◽

Shijin Wang ◽

Tinghui Xiao ◽

Wei Jiang ◽

Tianjian Zhou ◽

...

Keyword(s):

Intramedullary Nailing ◽

Closed Reduction ◽

Lateral Displacement ◽

Femoral Fractures ◽

Femoral Shaft ◽

Limb Length Discrepancy ◽

Bony Union ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Lateral Displacements

Abstract Background: Closed reduction and locked intramedullary nailing has become a common surgical method in the treatment of femoral shaft fractures. Overlap and rotation displacements can usually be corrected through the use of an orthopaedic traction table. However, lateral displacement and angulation persist. Methods: In this paper, we describe a joystick that can be used in the closed reduction of a fracture. It can correct lateral displacement and angulation and has the advantage of multi-direction reduction. The device described in this paper includes two parallel horizontal joysticks, one vertical main joystick and four assistant rods. Moreover, there are many specific spacing holes in the two parallel horizontal joysticks and a groove structure in the vertical main joystick. When the main “H” joystick is pressed, it can adjust lateral displacements and angulation because of the lever principle. The distance between parallel horizontal joysticks and assistant rods can be adjusted to the fracture position and body mass index of different patients. Results: The study participants consisted of 11 males and 5 females with a mean age of 31.0 years. All participants had good closed reduction and achieved bony union without any complications such as infection, nerve injury, nonunion, malunion and limb length discrepancy. By using an “H” joystick, closed femoral shaft fracture reduction and locked intramedullary nailing becomes simpler and faster. Conclusion: Based on the use of this instrument, we can easily and conveniently obtain the correct reduction situation, which leads to better surgical results. This device can be applied in the reduction of clinical femoral fractures and gradually extended to the reduction of other fractures.

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A Comparison of Complications and Union Rates in Intramedullary Nailing of Femoral Shaft Fractures Treated With Open Versus Closed Reduction

Orthopedics ◽

10.3928/01477447-20191223-03 ◽

2019 ◽

Vol 43 (2) ◽

pp. 103-107

Author(s):

Zachary L. Telgheder ◽

Matthew A. Albanese ◽

David S. Bloom ◽

Swamy Kurra ◽

Matthew P. Sullivan

Keyword(s):

Intramedullary Nailing ◽

Closed Reduction ◽

Femoral Shaft ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Open Versus

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A Clinical Comparison between Conservative Treatment and Intramedullary Nailing after Closed Reduction in the Treatment of Femoral Shaft Fractures of Children

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.1991.26.3.797 ◽

1991 ◽

Vol 26 (3) ◽

pp. 797

Author(s):

Chang Uk Choi ◽

Soo Kyoon Rah ◽

Jae Uk Kwon ◽

Jun Min Song ◽

Man Sik Yang ◽

...

Keyword(s):

Conservative Treatment ◽

Intramedullary Nailing ◽

Closed Reduction ◽

Femoral Shaft ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Clinical Comparison

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Percutaneous Skeletal Joysticks for Closed Reduction of Femoral Shaft Fractures During Intramedullary Nailing

Journal of Orthopaedic Trauma ◽

10.1097/00005131-200111000-00007 ◽

2001 ◽

Vol 15 (8) ◽

pp. 570-571 ◽

Cited By ~ 26

Author(s):

Gregory M. Georgiadis ◽

Alexandra M. Burgar

Keyword(s):

Intramedullary Nailing ◽

Closed Reduction ◽

Femoral Shaft ◽

Femoral Shaft Fractures ◽

Shaft Fractures

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The design of an “H” joystick for closed reduction and its application in segmental and comminuted femoral shaft fractures: an innovative technique

10.21203/rs.3.rs-26674/v1 ◽

2020 ◽

Author(s):

Zhaofeng Jia ◽

Shijin Wang ◽

Tinghui Xiao ◽

Wei Jiang ◽

Tianjian Zhou ◽

...

Keyword(s):

Intramedullary Nailing ◽

Closed Reduction ◽

Lateral Displacement ◽

Femoral Fractures ◽

Femoral Shaft ◽

Limb Length Discrepancy ◽

Bony Union ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Lateral Displacements

Abstract Background Closed reduction and locked intramedullary nailing has become a common surgical method in the treatment of femoral shaft fractures. Overlap and rotation displacements can usually be corrected through the use of an orthopaedic traction table. However, lateral displacement and angulation persist. Methods In this paper, we describe a joystick that can be used in the closed reduction of a fracture. It can correct lateral displacement and angulation and has the advantage of multi-direction reduction. The device described in this paper includes two parallel horizontal joysticks, one vertical main joystick and four assistant rods. Moreover, there are many specific spacing holes in the two parallel horizontal joysticks and a groove structure in the vertical main joystick. When the main “H” joystick is pressed, it can adjust lateral displacements and angulation because of the lever principle. The distance between parallel horizontal joysticks and assistant rods can be adjusted to the fracture position and body mass index of different patients. Results The study participants consisted of 11 males and 5 females with a mean age of 31.0 years. All participants had good closed reduction and achieved bony union without any complications such as infection, nerve injury, nonunion, malunion and limb length discrepancy. By using an “H” joystick, closed femoral shaft fracture reduction and locked intramedullary nailing becomes simpler and faster. Conclusion Based on the use of this instrument, we can easily and conveniently obtain the correct reduction situation, which leads to better surgical results. This device can be applied in the reduction of clinical femoral fractures and gradually extended to the reduction of other fractures.

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Closed intramedullary nailing of acute femoral shaft fracture: reduction with help of bone levers through a small incision without opening fracture site

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20180491 ◽

2018 ◽

Vol 6 (3) ◽

pp. 817

Author(s):

Amit Thakur ◽

Khalid Muzzafar ◽

Abdul Ghani ◽

Muhammad Haseeb

Keyword(s):

Surgical Technique ◽

Intramedullary Nailing ◽

Operation Time ◽

Femoral Shaft ◽

Functional Results ◽

Shaft Fracture ◽

Fracture Site ◽

Fracture Reduction ◽

Femoral Shaft Fractures ◽

Shaft Fractures

Background: Femoral shaft fractures are usually treated with intramedullary nailing. In this study, we report a modified closed surgical technique with reduction with bone levers through a small percutaneous stab incision without opening fracture site for this type of fracture.Methods: From June 2015-January 2017, this technique was used on 43 patients with femoral shaft fractures. Patients were followed up postoperatively for clinical evaluation. The surgical technique involves a mini-percutaneous incision slightly distal to the fracture site, and fracture reduction is performed with bone levers without opening the fracture site.Results: 39 patients were included in final assessment. 29 fractures (74.4%) healed in the first 6 month. 35 (89.7%) fractures were united by one year. 4 (10.3%) patients needed bone grafting. The functional results were considered excellent and good in 36 (92.3%) patients, 3 (7.7%) patients had poor results.Conclusions: The advantages of this procedure include that no fracture site is opened, there is a shorter operation time, less radiation exposure and it is especially suitable for multiple trauma and obese patients.

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Application of a Custom-designed External Fixation Restorer for Pediatric Femoral Fractures

10.21203/rs.3.rs-1195873/v1 ◽

2021 ◽

Author(s):

Yuchang Liu ◽

Jia-Yu Yuan ◽

Chunfang Li ◽

Xinjian Pei ◽

Yazhou Li

Keyword(s):

Closed Reduction ◽

Open Reduction ◽

Psychological Impact ◽

Femoral Fractures ◽

Femoral Shaft ◽

Partial Fracture ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Increased Risk ◽

New Type

Abstract Background: Closed reduction of pediatric femoral shaft fractures is one of the most difficult types of partial fracture reductions. Open reduction increases the harm to children. Although smaller invasive open reduction is mostly used at present, it has an impact on the microenvironment around the fracture and results in increased intraoperative bleeding, an increased risk of postoperative infection and surgical scarring, which has a great psychological impact on children. Methods: Given the above challenges, we propose another intraoperative reduction method. The technique described involves closed reduction and internal fixation for pediatric femoral shaft fractures using a new type of intraoperative fixator. Result: This technique brings hope that the success rate of closed reduction for pediatric femoral shaft fractures can reach 100%. Conclution: The method is demonstrated in a patient.

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