Butterfly Fragment in the Femoral Shaft Fractures Treated by Intramedullary Nail: Do We Need to Reduce It or Not?

Abstract Background: Limited data is available regarding the effect of gap size, fragment size and position of fragment on union in fragmented femur shaft fracture. The aim of the study is to analyze the effect of these parameters on union and determine cut-off values that necessitate reduction of fragment. Methods: Total of 59 patients with fragmented femur shaft fracture were reviewed and the effect of fragment size, gap size and fragment position on union were evaluated on 3rd, 6th and 12th month graphies from medical record of patients. Union rate was determined due to Radiographic Union Score of Femur. Patients were divided into small gap ( 10 mm) or large gap (10 mm), reverse fragment or non-reverse fragment and small fragment (50 mm) or large fragment (50mm) groups. Kruskal–Wallis Variance Analysis and Mann Whitney U test was used for comparisons among groups. The post-hoc Mann Whitney U-Test with Bonferroni Correction was used when the Kruskal Wallis Variance Analysis determined a significant difference.Results: In comparison of union scores of groups in regarding gap size and fragment size, there was not significant difference between groups at 3rd, 6th and 12th months. Union scores in the 3rd month (p=0,011) and 6th month (p=0,039) were lower in the reverse group than non-reverse group. But there was not statistically significant difference between two groups at 12th month (p=0.819). There was no significant difference in union rates in respect to intramedullary nail types. There was an indirect correlation between age and mean union score at 12th month. Conclusions: we could not determine any cutoff value regarding gap width and fragment size in the treatment of the femoral shaft fractures by IMN. Although there was a tendency to decrease in union scores due to the increase in the gap size, any significant difference was not determined. Only the reverse position of fragment had an adverse effect on the union until 6th months but the union score of reverse group reached the result of the non-reverse group by 12th months.

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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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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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Novel technique of removal of broken intra-medullary nail from femur with secondary DCS plating

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20213388 ◽

2021 ◽

Vol 7 (5) ◽

pp. 1039

Author(s):

Neetin Pralhad Mahajan ◽

Kartik Prashant Pande ◽

Pramod K. Bagimani

Keyword(s):

Femur Fracture ◽

Weight Bearing ◽

Femoral Shaft ◽

Shaft Fracture ◽

Femur Shaft Fracture ◽

Non Union ◽

History Of ◽

The Right ◽

Femur Shaft ◽

Subtrochanteric Femur Fracture

Femoral shaft fractures are one of the commonest fractures of the lower limb which are frequently operated with intramedullary nailing which enables immediate post-operative mobilization of the patient. There could be various causes of nail breakage – some of the notable being weight bearing over the non-union of the femur shaft, or a re-trauma over the operated limb causing both the implant and the nail to be broken. There are various methods of removal of the broken implant the commonest being the use of T-reamer technique. However not always can this be used due to varied intra-operative obstacles in different cases as described in this case below. We have a 35 year old male patient who was brought to us 2 hours after an alleged history of slip and fall following which he had sustained right sided subtrochanteric femur fracture with a broken implant – intramedullary interlock nail. The patient is a previously operated case of right sided femur shaft fracture with interlocking nailing done 15 years back. The patient was operated with – broken implant removal on the right side along with a secondary DCS plating with bone grafting for the subtrochanteric femur fracture. Intra operative period was met with a certain number of challenges and difficulties in view of a 15 year old implant for removal which was successfully with removed with DCS plating done. As is obvious with the above case, it would be quite imperative to say that older the implant, more difficult it becomes for its removal.

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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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A prospective randomized comparative study between trochanteric versus piriformis entry portal for intramedullary interlock nailing in the treatment of femoral shaft fracture

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20160711 ◽

2016 ◽

Vol 2 (1) ◽

pp. 18 ◽

Cited By ~ 1

Author(s):

Kanta Prasad Meena ◽

Mahendra Kumar Yadav ◽

Deepak Devatheya

Keyword(s):

Functional Outcome ◽

Femoral Shaft ◽

Shaft Fracture ◽

Fracture Site ◽

Entry Point ◽

Greater Trochanter ◽

Femoral Shaft Fractures ◽

Femoral Nailing ◽

Shaft Fractures ◽

Significant Difference

Background: In case of close nailing for femoral shaft fractures, the nail is inserted into the medullary cavity through the proximal femur without disturbing the periosteal blood supply of at the fracture site. The piriformis fossa and greater trochanter has been commonly described as starting points for antegrade femoral nailing. The purpose of this study was to compare results of two entry ports being used for intramedullary nailing for femoral shaft fractures.Methods: This study was conducted during a period of one year. The patients admitted with femoral diaphyseal fractures for antegrade nailing were divided in two groups alternatively for piriformis fossa entry point and greater trochanter entry point. Total number of patient in each group was 25 (n = 25). Functional outcome were analyzed at final follow up using Hari’s hip score.Results: There was no significant difference clinical and functional output in both group but intraoperative time and fluoroscopic time was significant (P <0.001).Conclusions: Femoral nailing through the greater trochanter entry portal with specifically designed nails should be considered a rational alternative to femoral nailing compared to Piriformis fossa entry portal with the benefit of reduced requirement for fluoroscopy and decreased operative time in obese patients. Statistically no significant difference (>0.005) in clinical and Functional outcome based on Hari’s hip score.

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