Nailing femoral shaft fracture with postless distraction technique: a new technique enabled by shape-conforming pad

Abstract Background Femoral shaft fractures are usually treated with nailing using a traction table and a perineal post, but this may occasionally result in various groin-related complications, including pudendal nerve neurapraxia. Although most of them are transient, complication rates of up to 26% are reported. Recently, postless distraction technique has been described for elective hip arthroscopy. In this study we compared post and postless distraction technique in femoral shaft fracture nailing in terms of (1) quality of reduction, (2) outcome, and (3) complications. Methods We reviewed 50 patients treated with postless distraction nailing technique for femoral shaft fractures and compared them with our historical case series (95 patients). The following data were collected for all patients: age, gender, weight, height, diagnoses (fractures were classified according to the 2018 revision of AO classification), type and size of nail surgical timing, Trendelenburg angles during surgery, quality of reduction according to Baumgaertner and Thoresen classifications, Modified Harris Hip Scores at 6 months, and perineal complications. Results Median age was 53 years, and median weight was 70 kg (range 50–103 kg). We found no significant difference in terms of quality of reduction (72 versus 74% “excellent” reduction for subtrochanteric fractures, while 81 versus 79% “excellent” reduction for femoral shaft fractures) and functional outcomes (Modified Harris Hip Score 74 versus 79). One patient in the control group had a failure of the fixation, and one patient in the postless group had a deep infection. Two patients in the control group reported pudendal nerve neurapraxia for 4 months, while none reported complication linked to the postless technique. Conclusions Our results using the postless distraction technique show a sufficient distraction to allow reduction and internal fixation of the femoral fracture with a standard femoral nail. Level of evidence: IV

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Role of Open Cerclage Wires Used in Patients with Comminuted Fractures of Femoral Shaft Treated with Intramedullary Nails

10.21203/rs.3.rs-49503/v1 ◽

2020 ◽

Author(s):

Tzu-Hao Wang ◽

Hao-Chun Chuang ◽

Fa-Chuan Kuan ◽

Chih-Kai Hong ◽

Ming-Long Yeh ◽

...

Keyword(s):

Femoral Shaft Fracture ◽

Femoral Shaft ◽

Shaft Fracture ◽

Fracture Treatment ◽

Union Rate ◽

Intramedullary Nails ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Significant Difference ◽

Cerclage Wiring

Abstract IntroductionThe role of open cerclage wiring in comminuted femoral shaft fracture treatment with intramedullary nails remains unclear. Here, we analyzed the effect of open cerclage wiring and the risk factors for nonunion after interlocking nailing in comminuted femoral shaft fracture treatment. We hypothesize that open cerclage wiring is applicable to patients with severe comminuted femoral shaft fractures without affecting bone healing.Patients and MethodsThis retrospective cohort study used data of consecutive patients who underwent interlocking nail fixation of a comminuted femoral shaft fracture between January 1, 2009, and December 31, 2016. First, eligible patients were divided into wire and no wire groups according to the surgical technique used and their union rate was recorded. The patients were then divided into union and nonunion groups and their perioperative data were analyzed.ResultsIn total, 71 comminuted femoral shaft fractures treated with interlocking nail fixation were included: 38 fractures (53.5%) augmented with the open wiring technique and 33 reduced with closed or mini–open wound without wiring. The wire group demonstrated significant improvements in fracture reduction compared with the no wire group, whereas no significant difference was observed in the union rate between the wire and no wire groups (p = 0.180). Moreover, 46 (65%) of 71 fractures united smoothly, and no significant difference was observed in any perioperative data between union and nonunion groups.DiscussionAugmented open cerclage wiring is indicated for comminuted femoral shaft fractures treated with intramedullary nails, even when the fragments are large or far displaced. Thus, open cerclage wiring can be used for fracture treatment, without decreasing the union rate.

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Outcome of Titanium Elastic Nailing in the Surgical Management of Femoral-Shaft Fracture in Children

Journal of KIST Medical College ◽

10.3126/jkistmc.v2i2.33755 ◽

2020 ◽

Vol 2 (2) ◽

pp. 61-66

Author(s):

Rajram Maharjan ◽

Rishi Bisht ◽

Dipesh Pariyar

Keyword(s):

Femoral Shaft Fracture ◽

Insertion Site ◽

Operating Time ◽

Femoral Shaft ◽

Shaft Fracture ◽

Age Group ◽

Femoral Shaft Fractures ◽

Titanium Elastic Nailing ◽

Shaft Fractures ◽

Fractures In Children

Introduction: Femoral shaft fracture is one of the most common orthopedic injuries of the children. These fractures treated non-operatively by traction followed by hip spica require prolonged hospitalization causing undue physical and psychological stress for patient and patient family. Loss of reduction is also commonly seen with hip spica that leads to unacceptable complications like angular deformities and limb length discrepancies. Titanium Elastic Nailing (TEN) is becoming widely accepted treatment for femoral shaft fractures in children due to its simplicity and physeal protective stable load sharing construct that allows early mobilization. The purpose of this study was to see the outcome of operative treatment of femoral shaft fracture in children by TEN. Methods: A retrospective observational study was carried out in the Department of Orthopedics in National Academy of Medical Sciences, National Trauma Center from February 2017 to January 2019. Study was undertaken in 22 children between the age group of 5-14 years with femoral shaft fractures. Fixation with TEN was done for all fractures within nine days of injury. Patients were assessed radiologically as well as clinically until fractures healed. The results were evaluated using Flynn scoring criteria. Results: Radiological union was seen in all cases between 6–12 weeks after surgery. The mean operating time was 58 (48-115) minute and mean hospital stay after surgery was 9 (6-15) days. Results were excellent in 14 patients (63.63%), satisfactory in 6 patients (27.37%) & poor in 2 patients (9%). Six patients had skin irritation at nail insertion site which resolved after removal of nails. Functional range of motion in both hip and knee joints of affected limb was preserved in all cases after the removal of nails. Conclusion: TEN is an effective and safe treatment of femoral shaft fractures in children of 5-14 years of age group.

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Determine the Mean Duration of Union in Femoral Shaft Fracture in Children Treated with Elastic Intra-Medullary Nailing

10.53350/pjmhs211551338 ◽

2021 ◽

Vol 15 (5) ◽

pp. 1338-1340

Author(s):

M. S. Zardad ◽

M. Younas ◽

S. A. Shah ◽

I. Muhammad ◽

M. Ullah ◽

...

Keyword(s):

Intramedullary Nailing ◽

Functional Outcomes ◽

Femoral Shaft Fracture ◽

Femoral Shaft ◽

Shaft Fracture ◽

Femoral Shaft Fractures ◽

Non Union ◽

Shaft Fractures ◽

Fractures In Children ◽

Medullary Nailing

Objective: The aim of this study is to determine the functional outcomes and mean duration of union in femoral shaft fracture in children treated with elastic intra-medullary nailing. Study Design:Retrospective Place and Duration: Conducted at Orthopaedic Unit Ayub Medical Teaching Institute Abbottabad and District Headquarter Teaching Hospital Gomal Medical College Dera Ismail Khan for duration from May 2020 to January 2021 (09 months). Methods: Total sixty eight patients with age ranges between 5-12 years were presented in this study. Patients detailed demographics age, sex and BMI were calculated after taking informed written consent. Complete patients were treated with elastic intramedullary nailing. Radiological assessment was done. Mean union time and complications associated to procedure were examined. Functional outcomes were analyzed according to the Flyn’s criteria. Follow-up was taken at 8 months postoperatively. Complete data was analyzed by SPSS 22.0 version. Results: Out of 68 patients, there were 48 (68.6%) males and 20 (31.4%) females. Most of the patients 41 (60.35) were aged between 8-12 years and the rest 27 (39.65%) were between 5-8 years.34 (50%) fractures were caused because of road accidents, falling from height were 20 (29.41%), due to sports were 10 (14.70%) and 4 (5.9%) were due to simple fall. 32 (47.06%) patients had left side fracture and 36 (52.94%) had right side fracture. Mean union time among patients was 4.14±2.72 months and there was no any case of non union. According to Flyn’s criteria, 50 (73.53%) cases had excellent results, 14 (20.6%) patients had good and fair results were among 4 (5.9%) cases. Complications were observed bone stiffness, delayed union and varus deformity among all cases. Conclusion: We concluded in this study thatElastic intramedullary nailing for femoral shaft fractures in children is safe and effective treatment modality. Union of bone achieved all the patients and majority of patients had excellent functional outcomes. Keywords: Femoral shaft fractures, Children, Elastic intra-medullary nail

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Management of compound fractures of shaft femur: a study of 55 cases

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164160 ◽

2016 ◽

Vol 2 (4) ◽

pp. 313

Author(s):

Gaurav Singla ◽

Amita Aggarwal ◽

Ravinder Singh

Keyword(s):

Femoral Shaft Fracture ◽

Weight Bearing ◽

Femoral Shaft ◽

Shaft Fracture ◽

Deep Infection ◽

Full Weight Bearing ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Mean Time

Background: Compound femoral shaft fractures are a major cause of morbidity and mortality. Conservative treatment necessitates a long stay in hospital for traction and subsequent immobilization and chances of wound infection are much higher. The objective of this study was to find out the outcome of treatment of open femoral shaft fractures by various modalities like interlocked nailing, plating and external fixation.Methods: Fifty five patients with open femoral shaft fractures were treated under spinal or general anaesthesia. These fractures were in proximal one third (n=3), middle third (n=29), distal third (n=21). Fifty patients underwent surgery within 5 days of injury. Patients were followed for a minimum of 12 Months.Results: Patients achieved union in an average time of 20 weeks (range 17 to 24 weeks). Full weight bearing was started in a mean time of 16 weeks. Mean duration of hospital stay was 20 days. Complications were occurred in ten patients (4 non-unions and 3 patients with deep infection and 3 patients developed chronic osteomyelitis). Conclusions: The results were excellent in 31, good in 13, fair in 3 and poor in 7 patients while one patient lost follow up as he was from far off place. We concluded that open femoral shaft fracture can be well managed by surgical intervention.

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Frequency of limb shortening in femoral shaft fractures treated by hip spica casting in children in Tertiary Care Hospital.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.11.3048 ◽

2019 ◽

Vol 26 (11) ◽

pp. 1873-1877

Author(s):

Muhammad Sajid Mehmood ◽

Sultan Shah ◽

Sajid Razzaq

Keyword(s):

Femoral Shaft Fracture ◽

Femoral Shaft ◽

Shaft Fracture ◽

Cross Sectional Study ◽

Care Hospital ◽

Sectional Study ◽

Cross Sectional ◽

Femoral Shaft Fractures ◽

Spica Casting ◽

Shaft Fractures

Objectives: In non-operative methods, hip spica casting is a gold standard for children under six years of age because of excellent bone union and remodeling qualities. The study was conducted to determine the frequency of limb shortening in femur shaft fractures in children treated by hip spica casting. Study Design: Descriptive cross sectional study. Setting: Orthopedics Department of Combined Military Hospital, Rawalakot, Pakistan. Period: One year from July, 2016 to June, 2017. Material and Methods: After approval of the study from institution’s ethical committee, all patients fulfilling the inclusion criteria were admitted through emergency or outpatient department for hip spica casting. It was descriptive cross sectional study and sampling was done by non-probability convenience sampling in 107 femur fracture patients treated by hip spica casting. Diagnosis of the fracture was based upon history of trauma with break in the continuity of shaft as seen by X-ray. Informed consent was obtained from parents/guardian to be included in the study. Results: The mean age was 5(± 2.04) years. Sixty eight percent patients were male and 32% were female. Sixty three percent patients had proximal femoral shaft fracture, 32% had middle femoral shaft fracture and 4% patients had distal femoral shaft fracture. The shortening of limb length was found in14% of patients. Conclusion: In closed femoral shaft fractures, hip spica casting is a safe treatment in children. It has a low risk of complications. We recommend its use except for open fractures, multiple fractures, or fractures in older children.

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Treatment of Adult Femoral Shaft Fractures Using the Perkins Traction at Addis Ababa Tikur Anbessa University Hospital: The Ethiopian Experience

International Surgery ◽

10.9738/cc48.1 ◽

2012 ◽

Vol 97 (1) ◽

pp. 78-85 ◽

Cited By ~ 13

Author(s):

Bahiru Bezabeh ◽

Biruk L Wamisho ◽

Maxime JM Coles

Keyword(s):

Range Of Motion ◽

Femoral Shaft Fracture ◽

Motor Vehicle ◽

Addis Ababa ◽

Femoral Shaft ◽

Shaft Fracture ◽

University Hospital ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Tertiary Teaching

Abstract This is a prospective study to evaluate the efficacy of the Perkins traction in the treatment of adult femoral shaft fractures from October 1, 2007, to the present at the Black Lion Hospital in Addis Ababa University Hospital in Ethiopia. All femur fractures admitted to the hospital were reviewed and evaluated for treatment. Black Lion Hospital (Tikur Anbessa) is the university hospital in Addis Ababa and the highest tertiary teaching hospital in a country of 85 million inhabitants. A 67-bed orthopedic department offers the main ground for teaching to the undergraduate medical students. The hospital is also the pivotal center for the formation of the orthopedic residents. Patients from different parts of the country are referred to this institution for orthopedic care. A total of 68 adult (older than 16 years) patients with 69 femoral shaft fractures were considered for treatment during the study period. Consent was obtained and prospective treatment initiated. A standard Perkins traction was applied by an orthopedic team composed of consultants, orthopedic residents, physical therapists, and nurses. A protocol was developed for patients undergoing such traction. The physiotherapists will supervise all individual or group therapy sessions. Progressive knee range of motion to facilitate quadriceps and hamstring muscle strengthening exercises were implemented four times a day and recorded. Demographic information, fracture patterns, duration of traction, thigh circumference leg length discrepancy, and pin sites were routinely monitored and charted. Data were computerized and analyzed weekly, and appropriate adjustments were made accordingly. Clinical evidence of a competent callus and confirmation by radiographic studies will influence the cessation of traction to allow gait training with toe-touch crutch ambulation. Progress will be monitored during the following outpatient visits in the fracture clinic. A total of 68 consecutive patients with 69 femoral shaft fractures were treated with the Perkins traction. There were 60 men (88.2%) and only 8 women (11.8%), for a ratio of 8 men to 1 woman. The age of the cohort patient varied between 18 and 28 years. The mechanisms of injury for most of the fractures were motor vehicle accidents, resulting in an isolated femoral shaft fracture in 49.2% of the patients. Half of the fractures were by means of closed injury (n = 44; 64.7%). One patient with a bilateral femoral shaft fracture was also added to the study. The right side was more often involved, with 41 fractures (60%), than the left, with 28 fractures (40%). Most of the fractures involved the proximal third of the femur (n = 34; 50%), but the most common fracture pattern was transverse (n = 29; 42.6%), followed by a comminuted pattern (n = 18; 26.5%). Three segmental fractures were also encountered. The mean hospital stay was 45 days (33 patients; 48.5%), with the length of time in traction varying from 30 to 40 days. Only 2 patients remained in traction for a period of 60 days. At the end of the traction period, 8 patients (11.8%) showed a decrease in the quadriceps mass, and 7 patients (10.3%) showed stiffness of the knee with a range of motion limited to 0° to 90°. Most patients were discharged after about 8 months of treatment. One patient suffered a nonunion, and one was malunited. Superficial pin care infections were noted in 8 patients (11.8%) and treated appropriately. The conservative treatment of 69 femoral shaft fractures using the Perkins traction at Black Lion University Hospital in Addis Ababa, Ethiopia, has been proven to be a safe and effective method. It should be encouraged in countries like ours where it is a luxury to have a C-Arm in the operating room and where the hardware often is not available to perform a stable stabilization of the long bone fractures.

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Short-term outcome of patients with closed comminuted femoral shaft fracture treated with locking intramedullary sign nail at Muhimbili Orthopaedic Institute in Tanzania

Tanzania Journal of Health Research ◽

10.4314/thrb.v17i3.8 ◽

2015 ◽

Vol 17 (3) ◽

Author(s):

Billy T. Haonga ◽

Felix S. Mrita ◽

Edmundo E. Ndalama ◽

Jackline E. Makupa

Keyword(s):

Femoral Shaft Fracture ◽

Callus Formation ◽

Femoral Shaft ◽

Shaft Fracture ◽

Limb Length ◽

Short Term ◽

Term Outcome ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Image Intensifiers

Background: Comminuted femoral shaft fractures are complex to treat because of increased risk of limb length discrepancies and mal-rotation deformities. Currently the interlocking intramedullary nail using image intensifiers is a suggested treatment for comminuted femoral shaft fractures. This study aimed to evaluate the short-term outcome of patients with closed comminuted femoral shaft fracture treated with locking intramedullary SIGN nail without image intensifiers at Muhimbili Orthopaedic Institute (MOI) in Tanzania.Methods: A prospective hospital base study was conducted on patients with closed comminuted femoral shaft fractures admitted at MOI from March 2011 to February 2012. A total of 91 adult patients (18 to 84 years) were enrolled in the study. Of the total patients, 80 (88%) patients were male, 11 were lost to follow-up, and 80 patients completed follow-ups of 18 weeks post operatively. Structured questionnaires and checklist forms were used to collect information. Operations were carried out either by antegrade or retrograde SIGN nail. Post operatively control radiographs, the lower limb length and mal-rotation deformities were assessed.Results: Comminuted femoral shaft fracture accounted for 20.3% of all adult femoral shaft fractures admitted at MOI. Deep wound infection occurred in 2.5%. Shortening of 2-3cm was seen in 3.8% of the patients. No patient had shortening of more than 3cm. External rotation deformity of more than 20 degrees occurred in 6.3% of the cases. Internal rotation deformity of more than 15 degrees was seen in 7.9%. Knee flexion of less than 90 degree was encountered in 7.5% of patients. By 18th week 95% of the patients had callus formation. Conclusion: SIGN nail appears to be an effective treatment for comminuted femoral shaft fractures in settings where image intensifiers and fracture tables are not readily available. They have excellent to good outcomes in rate of callus formation, limb length and limb alignment outcomes.

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Role of open cerclage wiring in patients with comminuted fractures of the femoral shaft treated with intramedullary nails

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02633-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Tzu-Hao Wang ◽

Hao-Chun Chuang ◽

Fa-Chuan Kuan ◽

Chih-Kai Hong ◽

Ming-Long Yeh ◽

...

Keyword(s):

Femoral Shaft Fracture ◽

Femoral Shaft ◽

Shaft Fracture ◽

Fracture Treatment ◽

Union Rate ◽

Intramedullary Nails ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Cerclage Wiring ◽

The Wire

Abstract Introduction The role of open cerclage wiring in comminuted femoral shaft fracture treatment with intramedullary nails remains unclear. Here, we analyzed the effect of open cerclage wiring and the risk factors for nonunion after interlocking nailing in comminuted femoral shaft fracture treatment. We hypothesized that open cerclage wiring can be applied in patients with severe comminuted femoral shaft fractures without affecting bone healing. Patients and methods This retrospective cohort study used data from consecutive patients who underwent interlocking nail fixation of a comminuted femoral shaft fracture between January 1, 2009, and December 31, 2016. First, eligible patients were divided into the wire and no wire groups according to the surgical technique used, and their union rate was recorded. The patients were then divided into the union and nonunion groups, and their perioperative data were analyzed. Results In total, 71 comminuted femoral shaft fractures treated with interlocking nail fixation were included: 38 fractures (53.5%) augmented with the open wiring technique and 33 reduced with closed or mini-open techniques without wiring. The wire group demonstrated significant improvements in fracture reduction compared with the no wire group, whereas no significant difference was observed in the union rate between the wire and no wire groups (p = 0.180). Moreover, 46 (65%) of 71 fractures achieved union smoothly, and no significant difference was observed in any perioperative data between the union and nonunion groups. Discussion Augmentation with open cerclage wiring is indicated for comminuted femoral shaft fractures treated with intramedullary nails, even when the fragments are large or greatly displaced. Thus, open cerclage wiring can be used for fracture treatment without decreasing the union rate.

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Role of open cerclage wires used in patients with comminuted fractures of femoral shaft treated with intramedullary nails

10.21203/rs.3.rs-49503/v2 ◽

2021 ◽

Author(s):

Tzu-Hao Wang ◽

Hao-Chun Chuang ◽

Fa-Chuan Kuan ◽

Chih-Kai Hong ◽

Ming-Long Yeh ◽

...

Keyword(s):

Femoral Shaft Fracture ◽

Femoral Shaft ◽

Shaft Fracture ◽

Fracture Treatment ◽

Union Rate ◽

Intramedullary Nails ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Significant Difference ◽

Cerclage Wiring

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Bifocal Bone Transport over a Preexisting Nail to Treat a Septic Femoral Shaft Nonunion

Case Reports in Orthopedic Research ◽

10.1159/000501844 ◽

2019 ◽

Vol 2 (1-3) ◽

pp. 40-46

Author(s):

Haridimos Tsibidakis ◽

Francesco Guerreschi ◽

Fakher Fakhry ◽

Piero Poli ◽

Luca Grion ◽

...

Keyword(s):

Bone Healing ◽

External Fixator ◽

Intramedullary Nail ◽

Femoral Shaft Fracture ◽

Femoral Shaft ◽

Shaft Fracture ◽

Bone Transport ◽

Leg Length ◽

Femoral Shaft Fractures ◽

Circular External Fixator

Intramedullary nailing is the method of choice for the treatment of most femoral shaft fractures. However, it is not always an easy procedure with predictable results as leg length discrepancy as well as rotational and angular malunion may occur. Lengthening over an intramedullary nail (IMN) has become very common as it allows early removal of the external fixator. This report presents a case of an open femoral shaft fracture initially treated with an IMN and subsequently complicated by a septic nonunion. Union was obtained by bifocal bone transport with a circular external fixator over the preexisting nail without exchange or removal of the previously inserted IMN. In conclusion, the presence of an IMN supports osteotomy and regenerates bone during bone healing, prevents fracture and/or deformation of the regenerated bone, and reduces the time needed for the external fixator.

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