Early and mid-term outcomes of nonsurgical management of femoral shaft fractures with associated multiple injuries in school-age children

2021 ◽  
Author(s):  
Yi Qiao ◽  
Xiaodong Wang ◽  
Jin Dai ◽  
Yunfang Zhen
Keyword(s):  
Clinical Outcomes ◽  
Surgical Management ◽  
Femoral Shaft ◽  
High Energy ◽  
Lower Limbs ◽  
Multiple Injuries ◽  
School Age Children ◽  
School Age ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures

Abstract Background Femoral shaft fractures associated with multiple injuries are commonly encountered in school-age children. Clinical outcomes of non-surgical management of pediatric femoral shaft fractures with high-energy multiple injuries are not well characterized. In this study, we evaluated the early and mid-term clinical outcomes of non-surgical management of pediatric femoral shaft fractures with high energy multiple injuries in our setting. Methods Retrospective review of school-age children with femoral shaft fractures managed non-surgically at the orthopedics department over a 3-year period. Results Eleven patients (6 boys and five girls; mean age: 7.2 years) with femoral shaft fractures associated with multiple injuries qualified the inclusion criteria. All fractures in this study population were sustained in road traffic accidents. Seven patients recovered very well. Basic functional recovery of lower limbs was satisfactory. Two patients had residual joint dysfunction, 4 patients showed abnormal gait, while 4 patients showed varying degrees of limp because of lower limb length discrepancy. Conclusion Clinical outcomes of non-surgical management of pediatric femoral shaft fractures at our center were comparable to the outcomes of other management approaches. Conservative management that shortens the duration of hospital stay without increasing cost of management should be encouraged.

scholarly journals The Epidemiology of Adult Distal Femoral Shaft Fractures in a Central London Major Trauma Centre Over Five Years

2017 ◽  
Vol 11 (1) ◽  
pp. 1277-1291 ◽  
Author(s):  
Akib Majed Khan ◽  
Quen Oat Tang ◽  
Dominic Spicer
Keyword(s):  
Major Trauma ◽  
Femoral Fractures ◽  
Femoral Shaft ◽  
High Energy ◽  
Locking Plates ◽  
Mechanism Of Injury ◽  
Femoral Shaft Fractures ◽  
Technical Requirements ◽  
Shaft Fractures ◽  
Major Trauma Centre

Background:Distal femoral fractures account for 3-6% of adult femoral fractures and 0.4% of all fractures and are associated with significant morbidity and mortality rates. As countries develop inter-hospital trauma networks and adapt healthcare policy for an aging population there is growing importance for research within this field.Methods:Hospital coding and registry records at the central London Major Trauma Center identified 219 patients with distal femoral shaft fractures that occurred between December 2010 and January 2016. CT-Scans were reviewed resulting in exclusion of 73 inappropriately coded, 10 pediatric and 12 periprosthetic cases. Demographics, mechanism of injury, AO/OTA fracture classification and management were analyzed for the remaining 124 patients with 125 fractures. Mann Whitney U and Chi Squared tests were used during analyses.Results:The cases show bimodal distribution with younger patients being male (median age 65.6) compared to female (median age 71). Injury caused through high-energy mechanisms were more common in men (70.5%) whilst women sustained injuries mainly from low-energy mechanisms (82.7%) (p<0.0001). Majority of fractures were 33-A (52.0%) followed by 33-B (30.4%) and 33-C (17.6%). Ninety-two (73.6%) underwent operative management. The most common operation was locking plates (64.1%) followed by intramedullary nailing (19.6%).Interpretation:The epidemiology of a rare fracture pattern with variable degrees of complexity is described. A significant correlation between biological sex and mechanism of injury was identified. The fixation technique favored was multidirectional locking plates. Technical requirements for fixation and low prevalence of 33-C fractures warrant consideration of locating treatment at centers with high caseloads and experience.

A Comparative Study between Intramedullary Fixation and External Fixation of Femur Shaft Fracture in Polytrauma Patients in Jharkhand

2021 ◽  
Vol 8 (32) ◽  
pp. 2933-2937
Author(s):  
Supantha Panja
Keyword(s):  
Comparative Study ◽  
External Fixation ◽  
Intramedullary Nailing ◽  
Complication Rate ◽  
Gold Standard ◽  
Femoral Shaft ◽  
High Energy ◽  
Definitive Treatment ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures

BACKGROUND Femoral shaft fractures result from high energy trauma and maybe associated with life threatening conditions. Typical in younger people is associated with polytrauma. Though intramedullary nailing (IMN) is the gold standard option of treatment, external fixation (EF) can also be used temporarily or definitively, in such cases. The aim of this study was to compare the functional outcome of these two procedures. METHODS This prospective comparative study was conducted at our centre over a period of 6 years. Age, sex of the patients, laterality, type of fracture with mean follow up, union time, and complications such as delayed union, angular deformities, and limb length discrepancies were tabulated and compared. RESULTS There were more cases of open fractures in the EF group compared to IMN group. In the IMN group the average surgery duration was 95.76 minutes and it was 69.4 minutes in the EF group. The average time for bone union was 25.66 weeks in IMF group and 28.22 weeks in EF group. Complication rate was higher in EF group with 11 complications (7 major & 4 minor) compared to IMN group with only 6 cases presenting with complications (3 each of major & minor). CONCLUSIONS Though IMN is the gold standard in treatment of femoral shaft fractures, EF in polytrauma is an alternative method for definitive fracture stabilization, with minimal additional operative trauma and an acceptable complication rate. KEYWORDS Femoral Shaft Fractures, Intramedullary Nailing, External Fixation, Polytrauma, Definitive Treatment

scholarly journals Safety and efficacy of a novel cephalomedullary nail femoral shaft fractures: a retrospective observational cohort in 33 patients

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Jorge C. De Leon ◽  
Cooper B. Tye ◽  
Connor S. Breinholt ◽  
Khang H. Dang ◽  
Ravi A. Karia
Keyword(s):  
Failure Rate ◽  
Femoral Shaft ◽  
High Energy ◽  
Implant Failure ◽  
Cephalomedullary Nail ◽  
Safety And Efficacy ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures ◽  
Femur Shaft ◽  
Femur Shaft Fractures

Abstract Background Despite advances in femoral shaft fracture fixation, the nonunion rate remains relatively high; and there is limited data on the efficacy and failure rate of specific implants. A novel cephalomedullary nail provides the ability to treat femur shaft fractures in isolation, with associated ipsilateral femur injuries, and provides various options for proximal and distal fixation exists on the market; but literature remains limited on the safety and efficacy of this implant. The aim of this study is to evaluate the early failure rate of this cephalomedullary nail, while comparing the nonunion rate to what is currently presented in the literature. This study is the first of its kind in evaluation of a specific implant for treatment of femoral shaft fractures and ipsilateral pathology. Methods Patients over 18 years of age, with traumatic femur shaft fractures, treated with this particular cephalomedullary nail and available for a minimum of 3-month follow-up were included for analysis. Data was collected by retrospective chart review and review of existing radiographs. Demographic data, injury details, AO/OTA fracture classification, and implant details were recorded for each patient. Primary outcome measured was implant failures (screw or nail breakage). Secondary outcomes measured included malunion, nonunion, deep infection, post-operative complications, and need for reoperation. Results Of the 33 patients included for analysis, 1 patient went on to non-union. There were no cases of implant failure. The single nonunion was a high-energy mechanism, open fracture, and higher level AO/OTA classification. The remaining 32 reached radiographic union at 3 months. Conclusion The nonunion rate of this novel cephalomedullary nail is comparable to what is reported in the literature. This nail is a safe and effective implant to treat femoral shaft fractures with a variety of ipsilateral femoral shaft injuries and reliably leads fracture union. Further studies are needed analyzing implant failure and comparing specific implants.

scholarly journals Locking retrograde nail, non-locking retrograde nail and plate fixation in the treatment of distal third femoral shaft fractures: radiographic, bone densitometry and clinical outcomes

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Luigi Meccariello ◽  
Michele Bisaccia ◽  
Mario Ronga ◽  
Gabriele Falzarano ◽  
Auro Caraffa ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Bone Densitometry ◽  
Statistical Difference ◽  
Plate Fixation ◽  
Femoral Shaft ◽  
High Morbidity ◽  
Similar Data ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures ◽  
Retrograde Nail

Abstract Background Distal third femoral shaft fractures are characterized by increasing incidence and complexity and are still considered a challenging problem (high morbidity and mortality). No consensus on best surgical option has been achieved. This study aims to investigate radiographic, mineral bone densitometry and clinical outcomes of locking retrograde intramedullary (LRN) nailing, non-locking retrograde intramedullary nailing and anatomical locking plate to surgically treat distal third femoral shaft fractures in young adults. Our hypothesis was that there is no significant statistical difference among the surgical options in terms of results (radiographic, bone densitometry and outcomes assessment). Methods Retrospective study: 90 patients divided into three groups (group 1 LRN, group 2 NLRN, group 3 plating). Average age was respectively 42.67 (± 18.32), 44.27 (± 15.11) and 42.84 (± 18.32) years. Sex ratio F:M was respectively 2.75, 2.33 and 2.00. AO Classification, KOOS, NUSS and RUSH score, VAS, DEXA scans and plain radiographs were used. Evaluation endpoint: 12 months after surgery. Results There were no statistical differences in terms of surgery time, transfusions, and wound healing. Results were similar with regard to average time of bone healing, RUSH scores, VAS, KOOS, regression between RUSH and VAS, average correlation clinical–radiographic results and patients outcomes. Conclusions Our results showed no statistical difference in the use of LNR, NLNR and plating for treatment of distal third femur shaft fractures in terms of radiographic, bone densitometry and clinical outcomes. Good subjective and objective results are provided by all three techniques. The choice among the studied techniques must be based on surgeons’ experience, indications and subjective patients’ aspects. The absence of relevant similar data in the published literature does not allow definitive validation (or rejection) of our hypothesis. A more powered study with a bigger cohort is needed for definitive validation.

scholarly journals A study on role of intramedullary interlocking nailing in the complex femoral shaft fractures

2019 ◽  
Vol 5 (5) ◽  
pp. 843
Author(s):  
Veera Kumaran ◽  
Sachidhanandham .
Keyword(s):  
Weight Bearing ◽  
Femoral Fractures ◽  
Femoral Shaft ◽  
High Energy ◽  
Rotational Stability ◽  
Full Weight Bearing ◽  
Care Hospital ◽  
Femoral Shaft Fractures ◽  
Interlocking Nailing ◽  
Shaft Fractures

<p class="abstract"><strong>Background:</strong> Fractures of the shaft of the femur are a major cause of morbidity and mortality in patients who sustain high energy trauma. Morbidity arises from limb shortening, malalignment, knee contractures and other complications of fracture.</p><p class="abstract"><strong>Methods:</strong> The aim of our study is to analyze the results of complex femoral shaft fractures treated by intramedullary interlocking nailing in our institution. Totally 20 cases of complex femoral fractures from 2007-2009 were treated with intramedullary interlocking at Krishanakumar Orthopedic Care Hospital, Nagercoil were included in our study.<strong></strong></p><p class="abstract"><strong>Results:</strong> We found that fracture of femur is most common in 2nd, 3rd and 4th decade of life, with mean age of 35.85 years. Vehicular accident in 17 patients was observed to be the main cause of fracture in our series (85%). 4 patients started full weight bearing at 10th week, 9 patients were able to bear full weight at 12th week, 4 patients at 14th week and 2 at 16th week. Average time of full weight bearing was 12.4 weeks. One patient developed deep infection (osteomyelitis) at 12 weeks and later non union was seen and unable to bear full weight.</p><p class="abstract"><strong>Conclusions:</strong> Intramedullary interlocking nailing for complex femoral fractures has been established worldwide as the gold standard treatment because of its load sharing property, internal splinting, and rotational stability. These contribute the stable osteosynthesis.</p><p class="abstract"> </p>

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