Comparison of Retrograde Femoral Interlocking Nail Versus Dynamic Condylar Screw in Distal Femoral Shaft Fractures

Objective: The aim of this study is to compare the effectiveness of retrograde femoral interlocking nail versus dynamic condylar screw in distal femoral shaft fractures. Study Design: Prospective/Randomized comprehensive Place and Duration: Department of Orthopaedic Surgery Bahawal Victoria Hospital (BVH) / QAMC, Bahawalpur for duration of eight months i.e July 2020 to February 2021. Methods: Total 65 patients of both genders were presented in this study with age ranges between 20-40 years. Patients detailed demographics age, sex and BMI were calculated after taking informed written consent. Patients were divided into 2- groups, I and II Group I had 32 patients and underwent for retrograde femoral interlocking nail and group II had 33 patients and received dynamic condylar screw. Mean operative time, mean union time of bones and complications were calculated. Effectiveness among both groups was calculated by HSS score. Complete data was analyzed by SPSS 22.0 version. Results: Most of the patients were males 40 (61.54%) and 25 (38.46%) were females. Mean age of the patients in group I was 26.46±4.28 years and in group II mean age was 30.78±8.22 years. Mean operative time in group I was 82.8±7.14 minutes while in group II it was 90.6±8.19 minutes. Mean union time in group I was 22.7±2.5 weeks and in group II was 26.21±5.3 weeks. According to HSS score in group I 16 (50%) results were excellent, 11 (34.38%) was good, 3 (9.8%) showed moderate and 2 (6.25%) was poor, while in group II excellent results were 15 (45.45%), 10 (30.30%) was good, 5 (15.15%) showed moderate and 3 (9.09%) showed poor results. Complications were observed joint stiffness, delayed union, non union and varus deformity were significantly lower in group I as compared to group II. Conclusion: We concluded in this comparison of study that bothretrograde femoral interlocking nail and dynamic condylar screw was useful and effective methods for trauma in distal femoral shaft fractures. But less union time and good outcomes were observed in interlocking nail as compared to dynamic condylar screw. Keywords: Distal femoral shaft fractures, Trauma, Dynamic condylar, Interlocking nail

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Osteogenesis and Histostructure of Femoral Muscles When Modeling a Femoral Fracture with Immediate or Delayed Osteosynthesis Using an Interlocking Intramedullary Antegrade Rod

Biomeditsina ◽

10.33647/2074-5982-16-2-78-88 ◽

2020 ◽

pp. 78-88

Author(s):

G. N. Filimonova ◽

N. I. Antonov ◽

A. A. Emanov

Keyword(s):

Bone Healing ◽

Femoral Fractures ◽

Femoral Shaft ◽

Biceps Femoris ◽

Quadriceps Femoris ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Group I ◽

Intramedullary Rod ◽

Group Ii

Interlocked intramedullary osteosynthesis is the most common method for treating femoral shaft fractures. The aim — to reveal specifi c characteristics of the histostructure of canine femoral muscles when healing femoral fractures under osteosynthesis using interlocking intramedullary reinforcement with an antegrade metal rod. Femoral shaft fractures were modelled in 9 mongrel dogs. The fractures were fi xed with an intramedullary rod. In Group I (n=4), osteosynthesis was started immediately after bone injury. In Group II (n=5), osteosynthesis was started 4 days after fracture (delayed osteosynthesis). M. biceps femoris and M. quadriceps femoris were studied. In Group I and Group II, bone healing occurred following 42 and 70 days, respectively. A unifi ed bone marrow cavity and cortical layer had been formed by day 70 and day 100 in Group I and Group II, respectively. The histostructure of M. quadriceps femoris in Group I remained largely unchanged throughout the experiment, while M. biceps femoris underwent the process of structural reorganization on days 42 and 70 of the experiment. The Group of delayed osteosynthesis demonstrated changes in the histostructure of both muscles, including an increased diversity of fi bre diameters, an increased number of nuclei in myocytes, fi brosis of the interstitial space and perimysial arterial vessels. These changes were more pronounced in M. biceps femoris. Three months after injury, the histostructure of the muscles under study, even in the Group of delayed osteosynthesis, had no signifi cant differences and tended to the intact norm. In femoral fractures, the earliest possible fi xation of bone fragments with an inter locking antegrade intramedullary rod is recommended. A complete bone healing in such cases occurs a month earlier than in those with delayed osteosynthesis. The femoral muscles of the anterior group are injured to a lesser extent than those of the posterior group.

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Incidence, Costs and Predictors of Non-Union, Delayed Union and Mal-Union Following Long Bone Fracture

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15122845 ◽

2018 ◽

Vol 15 (12) ◽

pp. 2845 ◽

Cited By ~ 17

Author(s):

Christina Ekegren ◽

Elton Edwards ◽

Richard de Steiger ◽

Belinda Gabbe

Keyword(s):

Fracture Healing ◽

Hospital Admissions ◽

Femoral Shaft ◽

Hospital Length Of Stay ◽

Long Bone ◽

Future Research ◽

Related Factors ◽

Femoral Shaft Fractures ◽

Non Union ◽

Shaft Fractures

Fracture healing complications are common and result in significant healthcare burden. The aim of this study was to determine the rate, costs and predictors of two-year readmission for surgical management of healing complications (delayed, mal, non-union) following fracture of the humerus, tibia or femur. Humeral, tibial and femoral (excluding proximal) fractures registered by the Victorian Orthopaedic Trauma Outcomes Registry over five years (n = 3962) were linked with population-level hospital admissions data to identify two-year readmissions for delayed, mal or non-union. Study outcomes included hospital length-of-stay (LOS) and inpatient costs. Multivariable logistic regression was used to determine demographic and injury-related factors associated with admission for fracture healing complications. Of the 3886 patients linked, 8.1% were readmitted for healing complications within two years post-fracture, with non-union the most common complication and higher rates for femoral and tibial shaft fractures. Admissions for fracture healing complications incurred total costs of $4.9 million AUD, with a median LOS of two days. After adjusting for confounders, patients had higher odds of developing complications if they were older, receiving compensation or had tibial or femoral shaft fractures. Patients who are older, with tibial and femoral shaft fractures should be targeted for future research aimed at preventing complications.

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Interlocking nail for femoral shaft fractures: is dynamization always necessary?

International Orthopaedics ◽

10.1007/s00264-004-0627-1 ◽

2005 ◽

Vol 29 (2) ◽

pp. 101-104 ◽

Cited By ~ 20

Author(s):

D. Tigani ◽

M. Fravisini ◽

C. Stagni ◽

R. Pascarella ◽

S. Boriani

Keyword(s):

Femoral Shaft ◽

Femoral Shaft Fractures ◽

Interlocking Nail ◽

Shaft Fractures

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Fatigue Fracture of the Interlocking Nail in the Treatment of the Distal Part of the femoral Shaft Fractures

Journal of the Korean Fracture Society ◽

10.12671/jksf.1997.10.3.522 ◽

1997 ◽

Vol 10 (3) ◽

pp. 522

Author(s):

Won Sik Choy ◽

Hwan Jung Kim ◽

Kwag Won Lee ◽

Young Sik Min ◽

Ha Yong Kim ◽

...

Keyword(s):

Fatigue Fracture ◽

Distal Part ◽

Femoral Shaft ◽

Femoral Shaft Fractures ◽

Interlocking Nail ◽

Shaft Fractures

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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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Early Experience With the Use of an Interlocking Nail for the Repair of Canine Femoral Shaft Fractures

Veterinary Surgery ◽

10.1111/j.1532-950x.1996.tb01434.x ◽

1996 ◽

Vol 25 (5) ◽

pp. 397-406 ◽

Cited By ~ 25

Author(s):

I. DURALL ◽

M.C. DIAZ

Keyword(s):

Femoral Shaft ◽

Early Experience ◽

Femoral Shaft Fractures ◽

Interlocking Nail ◽

Shaft Fractures

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Breakage of intramedullary femoral nailing or femoral plating: how to prevent implant failure

European Journal of Medical Research ◽

10.1186/s40001-021-00630-7 ◽

2022 ◽

Vol 27 (1) ◽

Author(s):

Henrik C. Bäcker ◽

Mark Heyland ◽

Chia H. Wu ◽

Carsten Perka ◽

Ulrich Stöckle ◽

...

Keyword(s):

Risk Factors ◽

Plate Osteosynthesis ◽

Femoral Shaft ◽

Intramedullary Fixation ◽

Implant Failure ◽

Average Risk ◽

Rigid Fixation ◽

Femoral Shaft Fractures ◽

Non Union ◽

Shaft Fractures

Abstract Introduction Intramedullary (IM) fixation is the dominant treatment for pertrochanteric and femoral shaft fractures. In comparison to plate osteosynthesis (PO), IM fixation offers greater biomechanical stability and reduced non-union rates. Due to the minimally invasive nature, IM fixations are less prone to approach-associated complications, such as soft-tissue damage, bleeding or postoperative infection, but they are more prone to fat embolism. A rare but serious complication, however, is implant failure. Thus, the aim of this study was to identify possible risk factors for intramedullary fixation (IMF) and plate osteosynthesis (PO) failure. Materials and methods We searched our trauma surgery database for implant failure, intramedullary and plate osteosynthesis, after proximal—pertrochanteric, subtrochanteric—or femoral shaft fractures between 2011 and 2019. Implant failures in both the IMF and PO groups were included. Demographic data, fracture type, quality of reduction, duration between initial implantation and nail or plate failure, the use of cerclages, intraoperative microbiological samples, sonication, and, if available, histology were collected. Results A total of 24 femoral implant failures were identified: 11 IMFs and 13 POs. The average age of patients in the IM group was 68.2 ± 13.5 years and in the PO group was 65.6 ± 15.0 years, with men being affected in 63.6% and 39.5% of cases, respectively. A proximal femoral nail (PFN) anti-rotation was used in 7 patients, a PFN in one and a gamma nail in two patients. A total of 6 patients required cerclage wires for additional stability. A combined plate and intramedullary fixation was chosen in one patient. Initially, all intramedullary nails were statically locked. Failures were observed 34.1 weeks after the initial surgery on average. Risk factors for implant failure included the application of cerclage wires at the level of the fracture (n = 5, 21%), infection (n = 2, 8%), and the use of an additional sliding screw alongside the femoral neck screw (n = 3, 13%). In all patients, non-union was diagnosed radiographically and clinically after 6 months (n = 24, 100%). In the event of PO failure, the placement of screws within all screw holes, and interprosthetic fixation were recognised as the major causes of failure. Conclusion Intramedullary or plate osteosynthesis remain safe and reliable procedures in the treatment of proximal femoral fractures (pertrochanteric, subtrochanteric and femoral shaft fractures). Nevertheless, the surgeon needs to be aware of several implant-related limitations causing implant breakage. These may include the application of tension band wiring which can lead to a too rigid fixation, or placement of cerclage wires at the fracture site.

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A Novel Closed Reduction Technique for Treating Femoral Shaft Fractures With Intramedullary Nails, Haemostatic Forceps and the Lever Principal

10.21203/rs.3.rs-113768/v1 ◽

2020 ◽

Author(s):

Wei Shui ◽

Youyin Yang ◽

Xinling Pi ◽

Gang Luo ◽

Bo Qiao ◽

...

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Intramedullary Nail ◽

Operative Time ◽

Femoral Shaft ◽

Intraoperative Blood Loss ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Fracture Table ◽

Minimally Invasive Reduction

Abstract Background: Faster, easier, more economical and more effective versions of the minimally invasive reduction procedure for femoral shaft fractures need to be developed for use by orthopaedic surgeons. In this study, a fracture table was used to restore limb length, and long, curved haemostatic forceps and the lever principle were utilized to achieve minimally invasive reduction and intramedullary nail fixation of femoral shaft fractures.Methods: A retrospective analysis involving 20 patients with femoral shaft fractures reduced with a fracture table; long, curved haemostatic forceps; and the lever principle was conducted. The operative effect was evaluated on the basis of the operative time, reduction time, fluoroscopy time, and intraoperative blood loss.Results: All 20 cases were reduced in a closed fashion, and no conversions to open reduction were needed. The average operative time and fracture reduction time for all patients were 69.1±13.5 minutes (range, 50–100 minutes) and 6.7±1.9 minutes (range, 3–10 minutes). The fluoroscopy exposure time during the reduction process was 5–15 seconds, with an average time of 8.7±2.7 seconds. The average intraoperative blood loss was 73.5±22.5 mL (range, 50–150 mL). The patients exhibited excellent alignment in the injured limb after intramedullary nailing. Seventeen patients successfully completed a follow-up after fracture healing. The healing time ranged from 4 to 6 months.Conclusions: Displaced femoral shaft fractures in adults can be treated by a labour-saving lever technique involving fragments, 2 haemostatic forceps and soft tissue envelope-assisted closed reduction and intramedullary nail fixation. This technique is easy to perform; reduces blood loss, the fluoroscopy time and the surgical time for intraoperative reduction; and leads to excellent fracture healing.

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