Comparative Study of Management of Closed Comminuted Femoral Shaft Fractures with Closed Interlocking Intramedullary Nail and Open Reduction and Dynamic Compression Bridge Plating

Fracture shaft of the femur are life-threatening injuries and can cause severe permanent disability. Nowadays die interlocking nailing is regarded as the operative technique of choice for fracture shaft of femur. However, the advantages and disadvantages have rarely been compared with plate osteosynthesis. This is prospective study to compare the two methods of treatments in terms of time to union, hospital slay (including readmission), wound infection, shortening of limb, delayed union, malunion, joint stiffness and implant failure. 54 patients, age (16 to 66) years, were treated by DCP (22), and interlocking nail (24). Eight patients were lost to follow up. The study was conducted in Services Hospital, Department of Orthopaedics and Ittefaq Hospital, Lahore, Pakistan from June 1996 to Dec 1997. Written consent was taken regarding the type of surgery to be performed. Open fractures of Gustilo Grade n or in, femoral shaft fractures associated with other fractures of the same femur, fractures in immature skeleton and segmental fracture were excluded. Winquist and Hansen classification was used to classify fracture comminution. Patients were alternately allocated. In the plating group, primary bone grafting was done in all cases. Time to union in nailing group was 16.43t2.48 weeks and in plating 19.88±3.46 weeks, p-value<0.05. Mean hospital stay in nailing group was 12.8±2.75 day and plating group 21.1±2.73 days, p>0.05. There were 2 deep infections in the plating group and none in nailing group. There was no shortening of limb in die plating group but 2 patients in the nailing group had shortening of 2 cms. Delayed union occurred in 2 patients in nailing group but 5 in plating group. One patient in the nailing group had external rotation of at least 10 degrees and none in plating group. Two patients in the nailing group had knee stiffness and 6 patients in me plating group. One patient in the nailing group had a broken interlocking screw 2 patients in the plating group had bent plates. Closed interlocking intramedullary nailing as a method of treating closed communited femoral shaft fracture is better than plating in terms of rate of postoperative complication including infection.Key Words: Comminuted fractures shaft of femur, static interlocking nailing and bridge plating.

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Response to comments on “Interlocking nailing of femoral shaft fractures with an extremely narrow medullary canal is associated with iatrogenic fractures.”

Injury ◽

10.1016/j.injury.2020.06.048 ◽

2020 ◽

Vol 51 (10) ◽

pp. 2337-2338

Author(s):

Kai-Lan Hsu ◽

Fa-Chuan Kuan ◽

Hao-Chun Chuang ◽

Ming-Long Yeh ◽

Wei-Ren Su

Keyword(s):

Femoral Shaft ◽

Medullary Canal ◽

Femoral Shaft Fractures ◽

Interlocking Nailing ◽

Shaft Fractures

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Poor prognostic factors of femoral shaft fractures in children treated by elastic intramedullary nailing

SICOT-J ◽

10.1051/sicotj/2020031 ◽

2020 ◽

Vol 6 ◽

pp. 34

Author(s):

Alexandru Ulici ◽

Elena Odagiu ◽

Oana Haram ◽

Adelina Ionescu ◽

Gabriel Alin Sterian ◽

...

Keyword(s):

Postoperative Complications ◽

Intramedullary Nailing ◽

Femoral Shaft ◽

Delayed Union ◽

Elastic Stable Intramedullary Nailing ◽

Mechanism Of Injury ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Fractures In Children ◽

Elastic Intramedullary Nailing

Introduction: Femoral shaft fractures in pediatric patients are treated by elastic intramedullary nailing using titanium or stainless-steel nails. The elastic stable intramedullary nailing behaves as an internal splint, promoting early mobilization. This type of treatment involves a minimally invasive approach, no damage to the growth plates, and no impairment of femoral head blood supply. Purpose: The aim of our study was to identify the negative predicting factors that might lead to an increased complication rate after elastic stable intramedullary nailing of femoral shaft fractures in children. Methods: We conducted a retrospective study on 137 patients with femoral shaft fractures treated by elastic stable intramedullary nailing. Patients’ age ranged between 4 and 17 years. We used data from the medical records of the patients to evaluate postoperative complications. Plain radiographs were analyzed to determine the fracture type, fracture location, and postoperative complications such as delayed union, angular deformities, and limb length discrepancies. Multivariate analysis was conducted to identify predictors for poor outcomes. Results: Complications occurred in 29 patients (21%) and consisted of delayed union, axial deformities, or lower limb length discrepancies. In the group of patients that suffered from complications, mechanism of injury, age, and weight were significant. They were older by an average of 5 years; half of them weighed more than 50 kg and over a half were involved in a road traffic accident. Conclusions: Elastic nailing is a successful tool to treat femoral shaft fractures. Three factors were demonstrated to influence the outcome. The mechanism of injury, age > 11 years, and weight > 50 kg are the most important and are predictors for development of complications such as delayed union or deformity.

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An Occult Ipsilateral Femoral Neck Fracture Associated With Mid-Shaft Femur Fracture

Journal of Research in Orthopedic Science ◽

10.32598/jrosj.7.4.703.1 ◽

2020 ◽

Vol 7 (4) ◽

pp. 185-188

Author(s):

Shahin Talebi ◽

◽

Shayan Amjadi ◽

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Intraoperative Imaging ◽

Femoral Shaft ◽

Shaft Fracture ◽

Delayed Union ◽

Adverse Outcomes ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Neck Fracture

Occult ipsilateral femoral neck fractures associated with femoral shaft fractures are frequently missed. They may lead to adverse outcomes, such as fracture displacement and delayed treatment followed by poor outcomes, including delayed union, malunion, nonunion, and osteonecrosis, which may lead to early arthroplasty. These adverse effects can be prevented by the awareness of this combined injury pattern, the adequate preoperative and intraoperative imaging of the femoral neck, and proper treatment. A 27-year-old man was admitted with a displaced fracture of the right femur. Fluoroscopic evaluation was performed after the intramedullary nailing of the shaft fracture. The evaluation revealed an ipsilateral displaced femoral neck fracture, which was fixed with two cannulated screw inserted anterior to the nail. Between 2% and 9% of all femoral shaft fractures are associated with ipsilateral femoral shaft fractures. This case report necessitates the increase of awareness for the presence of associated femoral shaft and neck fractures in patients undergoing antegrade femoral nailing. Also, we recommend appropriate preoperative, intraoperative, and postoperative imaging.

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A STUDY ON FRACTURE OF FEMUR SHAFT TREATMENT WITH INTRAMEDULLARY INTERLOCKING NAILING

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i12.2333 ◽

2021 ◽

Vol 5 (12) ◽

Author(s):

Ashok Meena ◽

D S Meena ◽

Narendra Saini ◽

Poonam Meena

Keyword(s):

Traffic Accidents ◽

Femoral Shaft Fracture ◽

Road Traffic ◽

Femoral Shaft ◽

Shaft Fracture ◽

Delayed Union ◽

Interlocking Nailing ◽

Shaft Fractures ◽

Femur Diaphysis ◽

Femur Shaft

Background: Rigid interlocking nailing for femoral shaft fracture is ideal for use in adolescents in terms of stability of the fracture and convenience for the patient. Closed reduction and intramedullary interlocking nailing is the surgical treatment of choice for the closed shaft fractures of femur. Present study conducted to study the principles of intramedullary interlocking nailing and to assess the outcome of the patient. Methods: The present study comprises of 30 cases of fracture shaft of the femur in adults about >20 years old. All the fractures, which were included in the study were traumatic in origin, most of them are due to road traffic accidents. Results: The delayed union rate in our series was 6.67%. There were no non-unions. Conclusions: It is concluded that closed intramedullary interlocking nailing method given good result in treatment of shaft fractures of femur. Keywords: Intramedullary nailing, Femur, Diaphysis fractures, Interlocking

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

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20193585 ◽

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

Background: 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.Methods: 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.Results: 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.Conclusions: 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.

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COMPARISON OF CLOSED AND OPEN INTERLOCKING NAILING TECHNIQUES IN FEMORAL SHAFT FRACTURES

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2015/1167 ◽

2015 ◽

Vol 2 (49) ◽

pp. 8514-8518

Author(s):

Vanamali B Seetharamaiah ◽

Sunil Basavar ajanna ◽

Mahendra A R ◽

Ankith Naduvanahalli Vivekanandaswamy

Keyword(s):

Femoral Shaft ◽

Femoral Shaft Fractures ◽

Interlocking Nailing ◽

Shaft Fractures

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Bridge Plating of Comminuted Shaft of Femur Fractures

Journal of Nobel Medical College ◽

10.3126/jonmc.v3i1.12230 ◽

2015 ◽

Vol 3 (1) ◽

pp. 7-12

Author(s):

Mohammad Abul Kalam ◽

Pradeep Kumar ◽

Mohammad Afzal Hussain ◽

Iqbal Ahmad

Keyword(s):

Prospective Study ◽

Plate Osteosynthesis ◽

Femoral Shaft ◽

Invasive Technique ◽

Operating Table ◽

Femoral Shaft Fractures ◽

Femur Fractures ◽

Shaft Fractures ◽

Bridge Plate ◽

Bridge Plating

A prospective study of forty comminuted femoral shaft fractures, open and close, treated with a relatively minimally invasive technique termed as bridge plate osteosynthesis or biological fixation. Less invasive procedure, Short operative time and less blood loss was seen during surgical procedure. This prospective study was conducted at Nobel Medical College, Biratnagar from 2010 to 2011. This study was done because most of the femoral shaft fractures treated under C-arm mobile image intensifier but bridge plating system does not require such advanced costly equipment. Almost all cases were free from long term complications. All fractures healed within 6 months. Bone grafting was done for 2 cases as a secondary procedure. The complication of infections was seen in two of open fractures. This procedure can easily be carried out in general operating table by appropriable surgeons.DOI: http://dx.doi.org/10.3126/jonmc.v3i1.12230Journal of Nobel Medical CollegeVol. 3, No.1 Issue 6, 2014, Page: 7-12

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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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