Reosteosintezių po šlaunikaulio diafizės lūžių analizė

Andrius Vaitiekus, Mykolas Liubauskas, Igoris Šatkauskas Vilniaus universiteto Reumatologijos, traumatologijos-ortopedijos ir rekonstrukcinės chirurgijos klinika, Ortopedijos ir traumatologijos centras, Vilniaus greitosios pagalbos universitetinė ligoninė, Šiltnamių g. 29, LT-04130 VilniusEl. paštas: [email protected] Tikslas: Nustatyti reosteosintezių dažnį ir priežastis po šlaunikaulio diafizės vidurinio trečdalio osteosintezių. Ligoniai ir metodai: Retrospektyviai išanalizuotos 237 pirminės šlaunikaulių osteosintezės Vilniaus universitetinės greitosios pagalbos ligoninės (VGPUL) Ortopedijos ir traumatologijos centre nuo 2003 iki 2010 metų. Į galutinę analizę įtrauktos 229 osteosintezės. Visi ligoniai pagal taikytą osteosintezės metodą suskirstyti į grupes: osteosintezė DCP plokštele, intramedulinė osteosintezė vinimi (IMV) ir išorinė fiksacija AO aparatu (IF). Ieškota reosteosintezės priežasčių: mechaninių komplikacijų, pseudoartrozės, supūliavimo. Rezultatai: Pagal AO (32) klasifikacija A tipo lūžis diagnozuotas 133 (56,1 %) pacientams, B tipo – 67 (28,3 %), C tipo – 37 (15,6 %). DCP grupėje iš 150 pacientų 29 (19,3 %) peroperuoti dėl mechaninių komplikacijų, 17 (11,3 %) – dėl pseudoartrozės ir 4 (2,6 %) – dėl supūliavimo. IMV grupėje iš 52 operuotųjų nė vienas neperoperuotas dėl mechaninių komplikacijų, 3 (5,8 %) peroperuoti dėl pseudoartrozės ir 1 (1,9 %) – dėl supūliavimo. IF grupėje iš 27 operuotųjų 7 (26 %) peroperuoti dėl mechaninių komplikacijų, 10 (27 %) – dėl pseudoartrozės ir 10 (27 %) – dėl supūliavimo. Išvados: Osteosintezė intrameduline vinimi yra pranašesnis metodas už osteosintezę plokštele, nes pastarojoje grupėje reosteosintezių dažnis buvo didesnis. Rekomenduojame, jei įmanoma, šlaunikaulio diafizės lūžius gydyti osteosinteze intrameduline vinimi. Reikšminiai žodžiai: reosteosintezė plokštele, intramedulinė fiksacija, šlaunikaulio osteosintezės plokštele komplikacijos, pseudoartrozės. The analysis of reosteosynthesis after diaphyseal femur fractures Andrius Vaitiekus, Mykolas Liubauskas, Igoris Šatkauskas Vilnius Universitety, Clinic of Reumatology, Traumatology-Orthopedics and Reconstructive Surgery, Orthopedics and Traumatolgy Centre, Vilnius University Emergency Hospital,Šiltnamių Str. 29, LT-04130 Vilnius, LithuaniaE-mail: [email protected] Objective: To evaluate the rate of and reasons for reosteosynthesis after osteosynthesis of the middle third of the femoral diaphysis. Materials and Methods: Retrospectively, 237 medical histories of patients with diaphyseal femur fractures, who underwent primary femoral osteosynthesis in the Centre of Traumatology and Orthopaedics of the Vilnius University Emergency Hospital in 2003–2010 were analyzed; 229 osteosyntheses were enrolled into the final study. All patients, by the osteosynthesis method, were grouped into three groups: osteosynthesis with Dynamic Compression Plate (DCP), intramedullary nailing (IMN), and AO external fixation apparatus (EF). These groups were investigated for the reasons of reosteosynthesis (pseudarthrosis, mechanical complications, suppuration). Results: A fracture type (by AO classification) was diagnosed to 133 (56.1%), B type – 67 (28.3%), and C type to 37 patients (15.6%).In first group (DCP) there were 150 cases of osteosynthesis, from which 29 (19.3%) were reoperated on because of mechanical complications, 17 (11.3%) because of pseudarthrosis, and 4 (2.6%) because of suppuration. In the second group, there were 52 IM nailing cases, from which none were reoperated because of mechanical complications, altthough 3 (5.8%) had to be reoperated because of pseudarthrosis and one (1.9%) because of suppuration. In the third group, there were 27 external fixations of which 7 (26%), 10 (27%) and 10 (27%) were reoperated on because of mechanical complications, pseudarthrosis and suppuration, respectively. Conclusions: Osteosynthesis with intramedullary nail is a superior method to internal fixation with DCP, because the rate of reosteosynthesis after intramedullary nailing was lower. We recommend, when possible, to perform osteosynthesis with intramedullary nail for the treatment of diaphyseal femur fractures. Keywords: DCP plating, femoral shaft intramedullary nailing, femur plating complications, pseudoarthrosis.

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The Cortical Step Sign Fails to Prevent Malrotation of a Nailed Femoral Shaft Fracture: A Case Report

Case Reports in Orthopedics ◽

10.1155/2014/301723 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Taranjit Tung ◽

Ted Tufescu

Keyword(s):

Case Report ◽

Intramedullary Nailing ◽

Femoral Shaft Fracture ◽

Femoral Shaft ◽

Shaft Fracture ◽

Rotational Deformity ◽

Femoral Nailing ◽

Femur Fractures ◽

Clinically Significant

Intramedullary nailing has become the treatment of choice for diaphyseal femur fractures. Malrotation is a well-recognized complication of femoral nailing. Various techniques including the cortical step sign (CSS) have been described to minimize iatrogenic rotational deformity during femoral nailing. We present a case in which the use of the CSS resulted in a clinically significant malrotation requiring revision.

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Femoral diaphysis fractures: treatment with unreamed intramedullary nailing and its results

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20175938 ◽

2018 ◽

Vol 4 (2) ◽

pp. 180

Author(s):

Murat Demiroğlu

Keyword(s):

Intramedullary Nailing ◽

Femoral Shaft ◽

Deep Infection ◽

Femoral Diaphysis ◽

Mortality And Morbidity ◽

Lower Extremity Injuries ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Distal Side ◽

Extremity Injuries

Background: Femoral shaft fractures are an important cause of mortality and morbidity in the lower extremity injuries.Methods: 21 femoral body fractures of 19 adult patients were treated with the unreamed intramedullary nailing. Of 19 patients 14 were males and 5 were females.Results: All fractures healed. Deep infection was not encountered. According to the Thoresen criteria, the rate of excellent-good results was 78%. In two patients, who had also cranial trauma, development of excessive callus was observed. None of the patients required a secondary operation. Conclusions: Unreamed intramedullary nailing, if it can be implemented with closed technique and with double lock screw at the distal side, provides satisfactory results in the femoral shaft fractures.

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A comparative study of fracture shaft of femur in adults treated with broad dynamic compression plate versus intramedullary interlocking nail

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v12i2.15453 ◽

2016 ◽

Vol 12 (2) ◽

pp. 66-69

Author(s):

Sushil Thapa ◽

Shrawan Kumar Thapa ◽

Shankar Dhakal ◽

Rudra Marasini ◽

Bhadra Hamal ◽

...

Keyword(s):

Dynamic Compression ◽

Femoral Shaft ◽

Plate Versus ◽

Femoral Diaphysis ◽

Medical Sciences ◽

Significant Difference ◽

Lost To Follow Up ◽

Mean Time ◽

Time From Injury

Background and Objectives: Diaphyseal femur fracture is one of the commonest fractures to present in an emergency room. The objective of the study was to compare femoral shaft fractures treated using nail with those using plate and screws. Patients and Methods: We studied a total of 62 patients of fracture shaft of femur admitted in the Bharatpur Hospital, Bharatpur, Chitwan and National Academy of Medical Sciences, BirHospital,Kathmandu. Two cases were lost to follow up. Thirty cases were treated with plating and 30 cases with nailing. The age group was from 16-30 years. Fifty-three were male and seven were females. Fifty-eight patients had closed fracture and two had Gustillo Anderson grade I openfracture. Result: Time from injury to surgery was 19 days on an average. Mean time for union was more in patients treated by plating, 19.46 weeks as compared to nailing 14.78 weeks. We found one case of infection with plating and breakage of plate in four patients. One patient with nailing did not show any signs of healing and two had failure in case of nailing. Our series revealed 23(38.3%) excellent, five (8.3%) good and two (3.3%) poor results in patients who had nailing while 15 (25.5%) excellent, nine (15%) good, one (1.7%) fair and five (8.3%) poor in patients who had plating out of 30 patients in each group. Conclusion:In our study we found that there was no significant difference in outcomes between plating and intramedullary nailing of femoral diaphysis fracture in terms of union, infection and implant failure.JCMS Nepal. 2016;12(2):66-9.

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Analysis of the results of ipsilateral hip and shaft femur fractures treated with reconstruction-type intramedullary nail or various plate combinations

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20163173 ◽

2016 ◽

Vol 2 (4) ◽

pp. 208

Author(s):

Sreekanth Kashayi-Chowdoji rao ◽

Lalith Mohan Chodavarapu ◽

Bharath Reddy Buchupalli ◽

Chandrasekhar Patnala ◽

Vijaya Krishna Chilakamarri

Keyword(s):

Intramedullary Nailing ◽

Hip Fractures ◽

Plate Fixation ◽

Femoral Shaft ◽

Functional Results ◽

High Energy ◽

Femur Fractures ◽

Group I ◽

Neck Fracture ◽

Group Ii

Background: Ipsilateral femoral shaft and hip fractures are commonly encountered following high energy trauma. Despite many treatment methods, controversy exists regarding the optimal management of these fractures. This study was planned to compare reconstruction-type intramedullary nailing and various plate combinations on the fracture healing and functional outcome in patients with these fractures.Methods: 25 patients with ipsilateral femoral shaft and hip fractures were operated by one of the two modalities - cancellous lag screws or dynamic hip screw for fracture hip and compression plate fixation for fracture shaft of the femur (Group I, 13 patients) and Reconstruction-type intramedullary nailing alone (Group II, 12 patients) - depending on surgeon's preference. The functional results of the patients were assessed with the system used by Friedman and Wyman. Radiological and functional assessment was done by an independent evaluator blinded to the surgical procedure.Results: The mean age was 33.6±4.03 in group I and 35.3±4.04 years in group II (p=0.70). The average follow up was 15 months. The average union time for femoral neck fracture was 15.75±0.89 and 16.48±1.40 (p=0.36) weeks and for fracture shaft was 19.27±1.18 and 20.06±1.16 (p=0.15) in group I and group II respectively. 10 patients (76.9%) in group I and 9 (75%) in group II showed good functional results. Two patients needed re-operation in group I and one patient in group II.Conclusions: Ipsilateral femoral shaft and hip fractures can be treated satisfactorily either with nailing alone or various plate combinations with similar outcome.

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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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Clinical outcomes of intramedullary nailing of femoral shaft fractures with third fragments: a retrospective analysis of risk factors for delayed union

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2018-000203 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000203

Author(s):

Kosuke Hamahashi ◽

Yoshiyasu Uchiyama ◽

Yuka Kobayashi ◽

Goro Ebihara ◽

Taku Ukai ◽

...

Keyword(s):

Risk Factors ◽

Intramedullary Nailing ◽

Intramedullary Nail ◽

Open Fracture ◽

Femoral Shaft ◽

Delayed Union ◽

Ao Classification ◽

Femoral Shaft Fractures ◽

The Third ◽

Shaft Fractures

BackgroundThis study retrospectively evaluated the clinical outcomes of intramedullary nailing of femoral shaft fractures with third fragments and analyzed the risk factors for delayed union.MethodsRetrospective analyses involving 51 patients who underwent intramedullary nailing of femoral shaft fractures with third fragments (AO classification type B, 35 cases; type C, 16 cases) were conducted. Delayed union was defined as either more than 10 months required for callus formation in more than three of the four cortical bone surfaces observed in the frontal and lateral radiographic views or the requirement for additional surgery such as nail conversion or bone transplantation. Seventeen patients developed delayed union (D group). Thirty-four patients achieved bony union within 9 months (U group). The following background variables were compared between groups: age at the time of the injury; AO classification; ratio of open fracture; waiting period before surgery; rate of the infraisthmal fracture; diameter of the intramedullary nail; ratio of the intramedullary nail to the femur; length and displacement of the third fragment; and use of open reduction, poller screws, or dynamization.ResultsSignificant differences were found between the D and U groups for age (32.2±14.1 vs. 25.3±9.6 years), open fracture ratio (35.3% vs. 11.8%), and displacement of the third fragment (13.7±6.4 vs. 9±6.3 mm). Multiple logistic regression analysis only identified displacement of the third fragment as a risk factor for delayed union (p=0.03; OR 1.13; 95% CI 1.01 to 1.26).DiscussionDelayed union was observed in 17 cases (33.3%) after intramedullary nailing of femoral shaft fractures with third fragments. Displacement of the third fragment influenced delayed union.Level of evidenceLevel III.

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PMD49 MECHANICAL COMPLICATIONS ASSOCIATED WITH INTRAMEDULLARY NAILING FOR TROCHANTERIC, INTERTROCHANTERIC AND SUBTROCHANTERIC FEMUR FRACTURES

Value in Health ◽

10.1016/j.jval.2019.09.1461 ◽

2019 ◽

Vol 22 ◽

pp. S678

Author(s):

A.S. Chitnis ◽

M. Vanderkarr ◽

J. Ruppenkamp ◽

C.E. Holy ◽

C. Sparks

Keyword(s):

Intramedullary Nailing ◽

Mechanical Complications ◽

Femur Fractures ◽

Subtrochanteric Femur Fractures

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EARLY OUTCOMES OF FLEXIBLE INTRAMEDULLARY NAILING IN PEDIATRIC SHAFT OF FEMUR FRACTURES

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i6.6137 ◽

2021 ◽

Vol 71 (6) ◽

pp. 2157-60

Author(s):

Muhammad Umair Hashmi ◽

Muhammad Nadeem Ahsan ◽

Babar Bakht Chughtai ◽

Saqib Majeed

Keyword(s):

Intramedullary Nailing ◽

Intramedullary Nail ◽

Femur Fracture ◽

Fracture Site ◽

Medullary Canal ◽

Femur Fractures ◽

Flexible Intramedullary Nailing ◽

Mean Diameter ◽

Flexible Intramedullary Nail ◽

Age Range

Objective: To study the early outcomes and complications of fixation of pediatric shaft of femur fractures using flexible intramedullary nail. Study Design: Prospective observational study. Place and Duration of Study: Orthopedic Department, Bahawal Victoria Hospital Bahawalpur, from Jan to Jun 2021. Methodology: Children between the ages of 5-11 years with shaft of femur fractures were included in the study. Fixation of fracture was done using elastic intramedullary nail. Final outcomes of fixation were observed using Flynn and Schwend Scoring System. Six-month follow-up was done in all cases. Data was analyzed using SPSS-20. Results: Total 70 cases having shaft of femur fracture were included in the study. Age range of cases was 5-11 years with mean age of 7.75 ± 1.66 years and mean weight of 24.44 ± 4.77 kilograms. Mean diameter of femur medullary canal was 7.48 ± 0.63 millimeters and mean diameter of flexible nail was 3.03 ± 0.26 millimeters. Mean post-operative period of radiological union of fracture was 8.57 ± 1.05 weeks. Per-operatively, fracture site was approached in 4 (5.7%) cases. Migration of nail was not seen in any case. Final outcomes according to Flynn and Shwend Score were excellent in 62 (88.5%), satisfactory in 7 (10%) and poor in 1 (1.4%) case. Conclusion: Fixation of shaft of femur fracture using flexible intramedullary nailing technique is safe and reliable with good outcomes among children between 5-11 years of age.

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Outcome of Elastic Stable Intramedullary Nail in Length Unstable Diaphyseal Femur Fractures in Children: A Case Series

Journal of Institute of Medicine ◽

10.3126/jiom.v42i2.37531 ◽

2020 ◽

Vol 42 (2) ◽

pp. 26-28

Author(s):

Prawesh S Bhandari ◽

Suresh Uprety

Keyword(s):

Intramedullary Nailing ◽

Satisfactory Result ◽

Intramedullary Nail ◽

Femur Fracture ◽

Case Series ◽

Elastic Stable Intramedullary Nailing ◽

Male Predominance ◽

Elastic Stable Intramedullary Nail ◽

Femur Fractures ◽

Fractures In Children

Introduction Elastic stable intramedullary nailing (ESIN) has been a common method of treatment of diaphyseal femur fracture in children. Though they are used in length stable fracture with favourable results, their use is debated in case of length unstable variants. The objective of the study was to evaluate outcome of these nails in length unstable diaphyseal femur fracture in children. MethodsWe retrospectively reviewed seven fractures in seven children treated with ESIN for functional outcome. ResultsTotal of seven patients with seven unstable femur fractures were studied. There was male predominance with 71.4%. The fracture united at a mean duration of 12 wks. The overall Flynn scoring showed 71.4 % excellent and 28.6 % satisfactory result. ConclusionElastic stable intramedullary nailing can be safely used in length unstable variant of femur fracture in children.

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